- 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...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- The Cigna Group (Bloomfield, CT)
- **JOB DESCRIPTION: DENTAL DIRECTOR ** This individual should be passionate about Cigna Healthcare Dental & Vision, clinical dentistry, and contributing to our ... or penalties. Participate in state audits as the state Dental Director . + Ensure effective provider monitoring including Performance Monitoring, regional Grievance… more
- CVS Health (Hartford, CT)
- …is a remote position and may sit anywhere within the US The Lead Director , Solutions and Operations Excellence role within Medical Affairs works with clinical ... of health plan operations, regulatory requirements and intricacies of CM and UM workflow optimization. They will be responsible for leading the clinical team… more
- CVS Health (Hartford, CT)
- …it all with heart, each and every day. **Position Summary** The Executive Director , Strategic Finance will lead a newly established Strategic Finance function within ... actuarial science and broader healthcare strategy and operations, the Executive Director will partner closely with Market Finance, Network/Clinical, Actuarial, and… more
- Evolent (Hartford, CT)
- …Tasks are performed within the RN/LVN/LPN scope of practice, under Medical Director direction, using independent nursing judgement and decision-making, ... that do not meet established clinical criteria to the Medical Director . + Appropriately identifies and refers.... + Appropriately identifies and refers quality issues to UM Leadership. + Appropriately identifies potential cases for Care… more