- Humana (Boston, MA)
- …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 scope and complexity...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** **Position Summary:** The Director , Quality & Control Assurance reports to the VP of Quality & Control Assurance is responsible ... leadership and oversight for the Quality & Control Assurance within CCA's Compliance department. This position designs, continually matures, promotes, & develops a… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Sumitomo Pharma (Boston, MA)
- …highly motivated, and experienced individual for the position of **Senior Director , Pricing, Contracting Strategy & Analytics.** This position reports to the ... **Vice President, Strategic Pricing & Contracting** . The **Senior Director , Pricing, Contracting** Strategy & Analytics will have primary responsibility for… more
- Bear Mountain Health Care (Reading, MA)
- …Mountain Healthcare is looking for an experienced, motivated and creative Assistant Director of Nursing(ADON/ADNS) for our Reading, MA location. As the ADON/ADNS, ... their absence, you will oversee the entire team ensuring quality customer service and compliance with all federal, state and local rules and regulations, as well as… more
- Beth Israel Lahey Health (Charlestown, MA)
- …for Medicare and Medicaid Services (CMS) coding, billing, and compliance requirements. * Working knowledge of patient financial servies activities including the ... you're making a difference in people's lives.** Under oversight of the Director , the Manager, BILH Patient Financial Services Hospital Billing is responsible for… more
- Prime Therapeutics (Boston, MA)
- …and drives every decision we make. **Job Posting Title** Health Plan Account Dir - Remote **Job Description** The Health Plan Account Director is the line of ... + Support, and at times lead the development, negotiation and compliance of Line of Business (LOB)-specific client contracts; proactively analyze contract… more
- Prime Therapeutics (Boston, MA)
- …every decision we make. **Job Posting Title** Audit Coordinator Lead - Remote **Job Description** The Audit Coordinator Lead has business unit responsibility for ... complete Corrective Action Plans requested by clients, CMS, accreditation and internal compliance areas by communicating and driving with internal business areas +… more
- Prime Therapeutics (Boston, MA)
- …we make. **Job Posting Title** Physician Clinical Reviewer, MRx - Oncology - REMOTE **Job Description Summary** Key member of the utilization management team, and ... review process so as to reflect appropriate utilization and compliance with Prime's policies/procedures, as well as URAC and...+ On a requested basis, may function as Medical Director for select health plans or regions, assuming overall… more
- Bristol Myers Squibb (Boston, MA)
- …more: careers.bms.com/working-with-us . Reporting into the Medical Value Liaison Field Director , the Senior Medical Value Liaison (MVL)/Executive MVL is a ... product and disease state education to health care decision makers in compliance with all policies and procedures + Build strategic, long-term relations with… more
- Aveanna (Needham Heights, MA)
- …clinician will be responsible for managing and scheduling patient visits to ensure compliance with agency policies and applicable regulations and standards. + At the ... of the location and in collaboration with the clinical director . + Increasing autonomy in the role is encouraged...difference in the lives of our patients and families. Remote and hybrid work is limited to the United… more
- Philips (Cambridge, MA)
- …strive to maintain positive relationships with customers by driving the compliance of contractual obligations, identifying areas of improvement and program quality ... Management System (CMMS) support cases for field technicians + Support the compliance of the Philips Biomed/Clinical Engineering program which includes Centers for … more