- Eisai, Inc (Boston, MA)
- …customers based on the marketplace within which they operate. Work closely with Medicaid Director and other cross-functional teams to review and analyze ... At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides...for assigned regional payer accounts including Commercial, Medicare and Medicaid (State Medicaid agencies, managed Medicaid… more
- Commonwealth Care Alliance (Boston, MA)
- 011230 CA-Provider Engagement & Performance Position Summary: The Director of Provider Relations leads the strategic vision and operational execution of provider ... network performance, and ensuring compliance with regulatory standards. The Director drives initiatives that enhance operational engagement, member access, provider… more
- Commonwealth Care Alliance (Boston, MA)
- …in improvement to promote the development of a high quality team .collaboration with the broader clinical organization. - Ensures that utilization management ... training, and performance monitoring and - Leads the Utilization Management team in managing and continuously improving UM program design, policies, procedures,… more
- Commonwealth Care Alliance (Boston, MA)
- …staff, including nurse reviewers and support personnel. - Act as liaison with medical director , provider relations, case management and quality teams to support ... Management (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care… more
- Commonwealth Care Alliance (Boston, MA)
- …performance improvement. The LTSS Program Manager reports to the Senior Director of Delegation Partnerships and Provider Engagement. The Provider Engagement ... team is responsible for building and maintaining relationships with...Experience (must have):** + 5+ years + Experience with Medicaid and Medicare products and programs + Experience or… more
- Humana (Boston, MA)
- **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...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Boston, MA)
- …to adapt and the courage to innovate **Additional Information** Reports to the Lead Medical Director - North Central Medicaid Markets. The Medical ... caring community and help us put health first** The Medical Director relies on medical ...Medical Directors will learn North Central region state Medicaid requirements (currently VA, KY, OH, IN, WI) and… more
- Humana (Boston, MA)
- …party reporting including notification, collection, analyze, storage, and distribution. + Team representative and presenter for various Medicaid committee ... caring community and help us put health first** The Associate Director , Procurement generates and implements efficient sourcing and category management strategies.… more
- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Humana (Boston, MA)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture + Knowledge and experience with national guidelines… more
- Humana (Boston, MA)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture** + **Knowledge and experience with national guidelines… more
- Beth Israel Lahey Health (Charlestown, MA)
- …facilities, physician groups, performance networks, and community partners. As part of the leadership team , the Director will assist the VP and AVP to integrate ... to the AVP of Revenue Finance and Analysis, the Director will lead a team of 4-5...Director will develop long- and short- term Medicare, Medicaid , and other government reimbursement revenue strategies, oversee preparation… more
- Evolent (Boston, MA)
- …meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Boston, MA)
- …for 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 . We can offer you a meaningful way to...per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to… more
- Advocates (Framingham, MA)
- …that values the 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...teaching and consultation to other members of the multidisciplinary team , including students, if assigned. + Provides collaborative leadership… more
- Evolent (Boston, MA)
- …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 ... team . We can offer you a meaningful way to...timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to… more
- Commonwealth Care Alliance (Boston, MA)
- 011230 CA-Provider Engagement & Performance Position Summary: The Director of Provider Relations leads the strategic vision and operational execution of provider ... network performance, and ensuring compliance with regulatory standards. The Director drives initiatives that enhance operational engagement, member access, provider… more
- Evolent (Boston, MA)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... will be a key member of the utilization management team . We can offer you a meaningful way to...Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
- Bear Mountain Health Care (Boston, MA)
- …Healthcare is looking for an experienced, motivated and creative Assistant Director of Nursing(ADON)/Infection Control (ICP) for our Mattapan, MA location. As ... the nursing department. You will work closely with the Director of Nursing to improve the quality of patient...quality of patient care and services provided by your team . POSITION REQUIREMENTS: . Must have a current unencumbered… more
- Humana (Boston, MA)
- …to put those customers at the center of everything it does. The Director , Data Technology Solutions devises an effective strategy for executing and delivering on ... IT business initiatives. The Director , Data Technology Solutions requires an in-depth understanding of how organization capabilities interrelate across the function… more
