• Senior Fraud and Claims Risk…

    Citizens (Westwood, MA)
    …career with exciting new challenges and opportunities to stretch yourself. As the Director of First Line Risk, you will represent the first line of defense ... to policies and procedures. + Advise and help senior management understand and manage risk and help to allocate...and/or Senior Risk Managers primarily supporting the Fraud and Claims line of business Qualifications: + 8-12+ years experience… more
    Citizens (05/31/25)
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  • Claims Editing Specialist

    Commonwealth Care Alliance (Boston, MA)
    …under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible ... Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for...and Analytics + Direct and relevant experience with HCFA/UB-04 claims management , coding rules and guidelines, and… more
    Commonwealth Care Alliance (05/28/25)
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  • Global Medical Director , Evidence…

    Sanofi Group (Cambridge, MA)
    **Job title** : Global Medical Director , Evidence Generation - Insights and Strategy **Location:** Cambridge, MA, Morristown, NJ **About the Job** Sanofi's ... Evidence Generation Lead of the Next-Gen Immunology Franchise, the Medical Director will also be responsible for...expertise in developing RWE studies, as well as study management and publications. + Prior experience in claims more
    Sanofi Group (05/02/25)
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  • Medical Director - Medicaid N.…

    Humana (Boston, MA)
    …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in the… more
    Humana (05/14/25)
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  • Medical Director , Global…

    Otsuka America Pharmaceutical Inc. (Boston, MA)
    …medicines for those with CNS disorders, we are seeking a skilled and experienced Medical Director of CNS Early Assets, Global Medical Affairs, responsible ... , Franchise Lead CNS Early Assets. **Position Summary:** The Medical Director , Global Medical Affairs,...for any assigned assets in development. + Support lifecycle management initiatives and planning for assigned assets as applicable.… more
    Otsuka America Pharmaceutical Inc. (04/17/25)
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  • Medical Director - National Medicare

    Humana (Boston, MA)
    …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
    Humana (05/29/25)
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  • Medical Director - Care Plus…

    Humana (Boston, MA)
    …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
    Humana (04/24/25)
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  • Global Medical Director , Evidence…

    Sanofi Group (Cambridge, MA)
    **Job title** : Global Medical Director , Evidence Generation - Innovation & Partnerships **Location:** Cambridge, MA, Morristown, NJ **About the Job** Sanofi's ... Medical Evidence Generation Lead of the Next-Gen Immunology Franchise, the Medical Director will also be responsible for offering strategic insights and… more
    Sanofi Group (04/23/25)
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  • Director , Field Reimbursement…

    Otsuka America Pharmaceutical Inc. (Boston, MA)
    Director of Field Reimbursement Management (FRM) Position Overview We are seeking an experienced, transformative leader to serve as the Director of Field ... within the assigned region Key Competencies + Strategic leadership and team management + Patient-centric approach to healthcare delivery + Operational excellence and… more
    Otsuka America Pharmaceutical Inc. (05/23/25)
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  • Medical Director - Medicare…

    Humana (Boston, MA)
    …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 scope and complexity...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with… more
    Humana (04/24/25)
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  • Director , Global Clinical Development

    Otsuka America Pharmaceutical Inc. (Boston, MA)
    …personnel management experience, will support position at entry (Associate Director / Director ). + An advanced understanding of drug development principles and ... disciplines, including immunology, biostatistics, clinical pharmacology, formulation science, data management , and medical writing. + Experience with the… more
    Otsuka America Pharmaceutical Inc. (04/17/25)
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  • Director , Global Clinical…

    Otsuka America Pharmaceutical Inc. (Boston, MA)
    …personnel management experience, will support position at entry (Associate Director / Director ). + An advanced understanding of drug development principles and ... disciplines, including immunology, biostatistics, clinical pharmacology, formulation science, data management , and medical writing. + Complete understanding of… more
    Otsuka America Pharmaceutical Inc. (04/17/25)
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  • Medical Director - Medicare…

    Humana (Boston, MA)
    …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 scope and complexity...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with… more
    Humana (05/14/25)
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  • Product Management Director

    Elevance Health (Boston, MA)
    **Product Management Director - Provider Workflow & Quality Solutions** **Location:** Alternate locations may be considered. This position will work a hybrid ... life through home-care and community based services. The **Product Management Director ** will lead our Provider Workflow...with FHIR, HL7, or X12 standards for clinical and claims data preferred. + Experience working with provider groups,… more
    Elevance Health (05/22/25)
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  • Associate Director , Clinical Data…

    Blue Cross Blue Shield of Massachusetts (Boston, MA)
    …us transform healthcare? Bring your true colors to blue. What we need The Associate Director of Clinical Data Management will be a key leader in executing ... successful candidate will be responsible for leading the clinical data management function, providing strategic direction, and ensuring the delivery of high-quality,… more
    Blue Cross Blue Shield of Massachusetts (05/29/25)
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  • Director , Strategic Supply Chain…

    Celestica (Boston, MA)
    …New Hampshire City: Remote Employee US **Summary** We are currently seeking a ** Director , Strategic Supply Chain Management ** to join our team to be ... segment. The successful candidate will have significant experience in both customer management and execution of both strategic and tactical supply chain initiatives.… more
    Celestica (05/24/25)
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  • Associate Director , Channel Strategy…

    Otsuka America Pharmaceutical Inc. (Boston, MA)
    **Associate Director , Channel Strategy and Patient Affordability** The Associate Director , Channel Strategy and Patient Affordability reports to the Executive ... Director , Channel Strategy and Patient Affordability. The Associate ...business review development experience + Experience working in matrix management structure with project management , coordination and… more
    Otsuka America Pharmaceutical Inc. (05/29/25)
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  • Sr Director , Performance Suite Analytics

    Evolent (Boston, MA)
    …health outcomes and a more connected care journey. We are hiring for a Senior Director to join our Finance Team. The candidate selected for this role will be part ... and its customers in the Performance Suite where Evolent does not pay claims + Establish ideal data transfer protocols during client onboarding and implementation,… more
    Evolent (05/02/25)
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  • Senior Director , Global Clinical…

    Otsuka America Pharmaceutical Inc. (Boston, MA)
    …medicine and/or clinical pharmacology and associated disciplines (eg biostatistics, data management , medical writing). + An advanced understanding of clinical ... in support of domestic and international clinical development initiatives. The Senior Director , GCD works in a multidisciplinary matrix environment and supports the… more
    Otsuka America Pharmaceutical Inc. (04/17/25)
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  • Director , Specialty Pharmacy Operations

    Otsuka America Pharmaceutical Inc. (Boston, MA)
    …Specialty Pharmacy operations for OAPI The position will report to the Executive Director , Channel Strategy and Patient Affordability We are seeking a highly skilled ... and motivated Director of Specialty Pharmacy Operations to lead and oversee...with cross-functional teams, including Brand Marketing, Sales, Patient Access, Medical Affairs, and Regulatory, to integrate pharmacy operations seamlessly… more
    Otsuka America Pharmaceutical Inc. (05/23/25)
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