- Highmark Health (Providence, RI)
- …responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using ... Medical Policy criteria sets to evaluate the ... necessity and appropriateness of the requested treatment of service . Depending on the nature of the case, telephonic… more
- Elevance Health (Smithfield, RI)
- …our care management models for our National Account clients. The medical director will be responsible for supporting the clinical vision and implementation ... the health improvement tools offered to clients/ members. The medical director provides clinical expertise...clinical relevance to account reporting regarding use of medical services by members. Involved in identifying… more
- Humana (Providence, RI)
- …and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by other healthcare ... Humana policies, clinical standards, and (in some cases) contracts. The Medical Director provides medical interpretation and decisions about the… more
- Veterans Affairs, Veterans Health Administration (Framingham, MA)
- …provide oversight of practice management including direct provider supervision, operational issues and clinical performance. The Medical Director will have ... in Boston, Massachusetts in vibrant and diverse clinics. The Medical Director is responsible for ensuring that...> 8000 patients. This full-time position includes approximately 51% clinical time and 49% administrative time. This person will… more
- Advocates (Framingham, MA)
- …ideas and contributions of our staff. The Behavioral Health Regional Medical Director (RMD) is a leadership and clinical role within Advocates' Behavioral ... Health Services Division. The RMD serves as Medical Director for the clinics of an...+ Works with Chief Medical Officer and Clinical Directors to identify regional service and… more
- Boston Health Care for the Homeless Program (Boston, MA)
- …Director of Medical Respite, in close collaboration with the Medical Director , is responsible for the daily clinical operations of BHCHP's 104 beds of ... which harms us all. We provide community-based health care services that are compassionate, dignified, and culturally appropriate, incorporating...to medical respite; working closely with the Medical Director , Director and Associate… more
- Advocates (Framingham, MA)
- …to other members of the multidisciplinary teams, including students, if assigned. + Work with Medical Director and Clinical Program Director to develop ... **Overview** *Starting Salary: $255,000* The CBHC Psychiatrist provides team-based, direct clinical services to people served by Advocates' CBHC, including… more
- Tufts Medicine (Boston, MA)
- …health policy research. **Job Overview** Tufts Medical Center is seeking a Clinical Nursing Director reporting to our Associate Chief Nursing Officer for ... outcomes, evidence-based practices, and professional development of nursing staff. The Clinical Nursing Director SICU works collaboratively with other… more
- CVS Health (Providence, RI)
- …it all with heart, each and every day. **Position Summary:** The Executive Director , Business Operations - Clinical Nursing provides strategic leadership and ... direction for the Coram Infusion and Specialty Services nursing organization. This role oversees clinical and operational functions to ensure consistent,… more
- Boston University (Boston, MA)
- … Affairs** **Job Description** ** DIRECTOR OF PATIENT ENGAGEMENT, SDM Clinical Affairs** **Category** Boston University Medical Campus --> Professional **Job ... Date** 9/18/2025 **Salary Grade** Grade 50 **Position Type** Full-Time/Regular The Director of Patient Engagement is responsible for providing leadership, process… more
- Takeda Pharmaceuticals (Boston, MA)
- …to the best of my knowledge. **Job Description** **About the role:** Associate Director , Clinical Program Quality Investigations is responsible for ensuring the ... Program Quality team and share insights to trends to Clinical Pharmacovigilance and Medical Quality and R&D...and CAPA development. + Oversee the Serious Breach Reporting Service and ensure that the service is… more
- Prime Therapeutics (Providence, RI)
- …our passion and drives every decision we make. **Job Posting Title** Sr Director Clinical Strategy and Oncology Specialty Solutions/PharmD required- REMOTE **Job ... Description** The Senior Director Clinical Strategy and Oncology Specialty Solutions...the development of strategic business roadmaps that integrate both medical and pharmacy solutions. This position will provide leadership… more
- Highmark Health (Providence, RI)
- …anchor, including MAQCs and pharmacists, in collaboration with the partnership director who manages non- clinical workforce activity. + **Relationship Management ... :** **JOB SUMMARY** This role will support the leadership team for Clinical Transformation and executive physicians in leading the day-to-day operational model of… more
- Cognizant (Providence, RI)
- …submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... denials including but not limited to referral, preauthorization, medical necessity, non-covered services , investigational/experimental and billing resulting… more
- IQVIA (Boston, MA)
- **Position Overview:** IQVIA is seeking an experienced Associate Clinical Project Management Director /Trial Delivery Manager (TDM) to lead and coordinate global ... role that may require some travel IQVIA is a leading global provider of clinical research services , commercial insights and healthcare intelligence to the life… more
- Grifols Shared Services North America, Inc (Cranston, RI)
- …(MSL primary call points include Immunology, Neurology, Hematology/Oncology). The Field Director ensures compliant execution of field medical plans, strategy, ... and develop, produce and market innovative medicines, solutions and services in more than 110 countries and regions. The...solutions for the therapeutic area(s). + Partners with the Medical Directors, National MSL Sr Director , and… more
- Beth Israel Lahey Health (Boston, MA)
- …in quality of care, access, overall customer satisfaction, communication, clinical services delivery, operating efficiency, budget management, program ... in people's lives.** Job Summary: Leads operational initiatives in assigned areas and services in order to achieve set goals. Goals will target improvements… more
- Humana (Providence, RI)
- …processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, ... , requested level of care, and/or requested site of service should be authorized. All work occurs with a...**Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided… more
- Humana (Providence, RI)
- …an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare ... clinical documentation, dispute/grievance and appeals processes, and outpatient services and equipment, within their scope. Medical ...a Lead Medical Director . The Medical Director conducts post- service , inpatient… more
- State of Massachusetts (Westborough, MA)
- …assigned. Working with fellow Nurse Reviewers, OLTSS program staff, and the OLTSS Senior Medical Director to identify key clinical problems facing OLTSS ... they have the skills necessary to thrive to apply for this role. **Job:** ** Medical Services * **Organization:** **Exec Office Of Health and Human Services *… more