- Humana (Hartford, CT)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Hartford, CT)
- …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... and preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- Humana (Hartford, CT)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- CVS Health (Hartford, CT)
- …We are seeking a strategic and technically proficient leader to oversee Medicare data science initiatives supporting actuarial analytics and pricing. The ideal ... candidate will have deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management, and pricing strategies. This role requires a strong… more
- CVS Health (Hartford, CT)
- …We are looking for a Principal Data Scientist to join our Aetna Medicare (STARS Portfolio) team at CVS Health. This high-level individual contributor will partner ... closely with the Executive Director of Aetna STARS Analytics to drive hands on...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- Humana (Hartford, CT)
- …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... health, SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services… more
- Humana (Hartford, CT)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and … more
- Humana (Hartford, CT)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (Hartford, CT)
- …lead Medical Directors performing utilization management for inpatient authorizations training medical director team to assist and facilitate new hires and ... remediation of medical directors performing Medicare utilization management processes...rate with denials and overturns. Deliver the upmost consistent medical director decision making. + _Internal Operations… more
- CVS Health (Hartford, CT)
- …day. **Position Summary** Aetna, a CVS Health company, has an outstanding opportunity for a Medical Director . Ready to take your career to the next level with a ... anywhere in the United States. In this role as Medical Director MPO ( Medical Policy...and predetermination of covered benefits in the Commercial and Medicare environment. In addition, be a subject matter expert… more
- Evolent (Hartford, CT)
- …business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical ... questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Hartford, CT)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Hartford, CT)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Hartford, CT)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management ... recorded in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Evolent (Hartford, CT)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be a key member of the utilization ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- CVS Health (Hartford, CT)
- …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...medical license. Internal Medicine background Have experience in Medicare and Medicaid **Education** *M.D. or DO, Board Certification… more
- National Health Care Associates (East Hartford, CT)
- …understanding of Electronic Medical Record (EMR), PDP, MDS 3.0, Medicaid and Medicare requirements + Interest in the nursing needs of the aged and the ... Place to Work** Riverside is a proud affiliate of National Health Care Associates. As a Certified Great Place...We invite you to join our team! **-** **MDS Director MUST HAVE EXPERIENCE** **$1500 Sign on bonus!** **What… more
- CVS Health (Hartford, CT)
- …of our members' health care and social determinant needs. The Case Management (CM) Medical Director will participate in executing and deploying our Models of ... Meetings as indicated **Required Qualifications** * Active and current medical license (MD or DO) without encumbrances * Board...business needs * 3-5 years of Managed Care experience; Medicare highly preferred * 3-5 year of Case Management… more
- Evolent (Hartford, CT)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... in Cardiology** (with Cardiology training and clinical experience). + **Unrestricted medical license** in the state of residence and willingness to obtain… more
- Humana (Hartford, CT)
- …We are seeking an experienced and strategic leader to fill the position of Director of Internal Pharmacy Forecasting and Performance Analytics. This role will lead a ... of five direct reports and 1-2 indirect reports. The Director will play a key role in driving business...leader will need deep understanding of the complexities of Medicare Part D benefit design and regulatory changes to… more