- Abt Global Inc. (Cambridge, MA)
- **The Opportunity** As a Project Director , you will lead large project teams through complex health analytic engagements, serving both State and Federal ... strategy, and visualization. You will help to operationalize and execute Medicaid policy and IT transformation projects. You will oversee interdisciplinary teams… more
- Humana (Boston, MA)
- …to innovate + **Resides in KY** **Additional Information** Reports to the Lead Medical Director - North Central Medicaid Markets. The Medical Director ... community and help us put health first** The Medical Director relies on medical background and reviews health claims.... market populations. May provide cross-coverage for other state Medicaid markets. May participate on project teams… more
- Cognizant (Boston, MA)
- …among patients, hospitals, and government agencies to ensure eligibility for Medicaid , social security, county indigent, or other types of healthcare funding. ... process, standards, and documentation by client. + Evaluates and reports project status, schedules, issues, resolutions, and completions. + Guide underperforming… more
- Humana (Boston, MA)
- …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 ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Boston, MA)
- …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 ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Boston, MA)
- …part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... health, DME, skilled nursing facility and waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by other… more
- Humana (Boston, MA)
- …us put health first** Humana is seeking a strategic and experienced Director of Business Performance Management, to lead the development, implementation, and ... effectiveness, compliance, and the achievement of key business objectives. The Director will be responsible for establishing clear performance metrics, driving… more
- Prime Therapeutics (Boston, MA)
- …our passion and drives every decision we make. **Job Posting Title** Product Director - State Public Sector Business Development - Remote **Job Description** This ... Business Development Product Director is accountable for developing and executing initiatives on...commercial products to shape it for state public sector, Medicaid FFS business. + Pulls in account team "Product… more
- Prime Therapeutics (Boston, MA)
- …our passion and drives every decision we make. **Job Posting Title** Senior Director Clinical Account Management - Remote **Job Description** The Sr Director ... with clients; participates in request for proposals; account leadership during project implementations. + Review and assign account executive's book of business… more
- Takeda Pharmaceuticals (Lexington, MA)
- …true to the best of my knowledge. **Job Description** **Associate Director , Access Marketing, Entyvio** **Takeda Pharmaceutical** **Lexington, MA** **About the ... will inspire you and empower you to shine? Join us as the Associate Director , Access Marketing, Entyvio. This position reports into the Director , Access… more
- Sanofi Group (Cambridge, MA)
- **Job Title:** Associate Director , DUPIXENT Payer Analytics and Insights Lead - US **Location:** Cambridge, MA **About the Job** Associate Director , Dupixent ... This position is be based in Cambridge, MA and reports to Director , Dupixent Payer Analytics and Insights Lead. **Main Responsibilities:** + Support integrated… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Director , Risk Adjustment Strategy Advancement will provide business intelligence and strategic planning ... support for business segments and the company at large. The Director , Risk Adjustment Strategy Advancement requires an in-depth understanding of how organization… more
- AmeriHealth Caritas (Manchester, NH)
- …administrative services. Discover more about us at www.amerihealthcaritas.com . The Director of Provider Network Management will develop and manage all hospital, ... and contracting terms. + 1 to 2 years of Medicaid experience preferred. + A minimum of 8 to...of 5 years of management experience, managing teams, and project management is preferred. + A valid Driver's License… more
- State of Massachusetts (Boston, MA)
- …Care Division * In 2023, Inspector General Jeffrey Shapiro shifted the review of Medicaid (MassHealth) and the Health Safety Net (HSN) programs to the newly created ... $20.3 billion on MassHealth Administered by the Office of Medicaid , HSN provides access to essential health care services...the MassHealth and HSN programs. * Working with the Director to propose recommendations to address identified risks and… more
- Prime Therapeutics (Boston, MA)
- …in business requirements, system specifications, process flows, process change and/or project management in supporting Compliance with Medicaid requirements. + ... + Advise internal clients regarding compliance with State and Federal Medicaid regulatory and contractual requirements + Provides leadership to the business… more
- Commonwealth Care Alliance (Boston, MA)
- …Duties & Responsibilities: The Manager, Utilization Management reports to the Director of Utilization Management * Oversees clinical decision review for services ... knowledge of and compliance with CMS, NCQA and state Medicaid requirements. * Lead preparation for internal and external...and support personnel. * Act as liaison with medical director , provider relations, case management and quality teams to… more
- Fresenius Medical Center (Waltham, MA)
- …to assure proper direction is obtained. + Assuring compliance with Medicare/ Medicaid requirements and regulations by: + Maintaining current knowledge on Medicare, ... implementation. + Ensure each new site implementation has a project plan in place and monitors the progress and...of operations) and participate in conferences. **SUPERVISION:** + FVC Director of Revenue Cycle + FVC Manager of Revenue… more
- Humana (Boston, MA)
- …The Senior Procurement Professional will report directly into the Associate Director of Procurement and will create category strategies, design sourcing plans, ... levels within the business and sourcing environments **Preferred Qualifications:** + Project Mgt experience + Experience with metrics and reporting **Additional… more
- Evolent (Boston, MA)
- …issue resolution, process improvement, and more. This position reports to the Director . Provider Data Managment. + Leadership responsibility for a team of 3-7 ... + Use data-driven decision-making skills to effectively prioritize day-to-day operations, project work, and address client requests and escalations + Identify areas… more
- Prime Therapeutics (Boston, MA)
- …+ Excellent quantitative, problem solving, and analytical skills + Strong project management and organizational skills + Excellent verbal and written communication ... or PBM + Previous experience pricing Commercial, Medicare or Medicaid lines of businesses + 5 years of experience...**Reporting Structure** + Reports to Senior Principal or Senior Director in the Finance department Potential pay for this… more