- Humana (Providence, RI)
- **Become 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...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- Humana (Providence, RI)
- **Become 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...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Humana (Providence, RI)
- …Information** Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director , depending on size of region or line ... caring community and help us put health first** The Medical Director relies on medical ...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- CVS Health (Providence, RI)
- …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...business strategies and products + Experience in large, matrixed corporate environment + Experience working with end-users **Education:** +… more
- Humana (Providence, RI)
- …Information** Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director , depending on size of region or line ... caring community and help us put health first** The Medical Director relies on medical ...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Point32Health (Canton, MA)
- …service lines for Medicare , Medicaid and Commercial product lines. The Director also identifies opportunities to reduce medical and administrative costs by ... to our members, partners, colleagues and communities. **Job Summary** The Director , Ancillary Contracting leads the development and management of Point32Health's… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... changes at the request of the assigned provider. + Adhere to departmental, corporate standards and policy and procedure (ie, Fallon Health Service Level agreements)… more
- Point32Health (Canton, MA)
- …and trend to aid in managing pharmacy costs. + Collaborate with the Pharmacy Medical Director and Marketing to develop member and provider specific communication ... to meet regulatory and accreditation requirements and to meet Point32Health's corporate priorities. The Senior Clinical Pharmacist also oversees the structure and… more
- Fallon Health (Worcester, MA)
- …is responsible for the presentation of the member appeal to the FH Medical Director , Center for Medicare /Medicaid Services, contracted reviewer, as ... staff. Work with Team Leaders, Department Managers, Department Chairs and/or Medical Director to resolve member complaints; formulate improvement measures… more
- Point32Health (Canton, MA)
- …partners, colleagues and communities. **Job Summary** Under direction of the Director , Customer Experience (CX), the CX Measurement & Improvement Program Manager ... compliance requirements are met, including staying up to date on all Center for Medicare & Medicaid Services (CMS) memos and notices. + Ensures all survey content,… more