- Humana (Boston, MA)
- **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 (Boston, MA)
- **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. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Possess analysis… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …Scientist supports analytic activities associated with BCBSMA overall performance on Medicare Stars ratings, with specific focus on CAHPS patient experience ... to help identify the most efficient means through which Medicare Stars clinical quality and patient experience performances at...into a cohesive view. Under direction of the Senior Director of Population Health Analytics, the Data Scientist will… more
- Humana (Boston, MA)
- …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
- Humana (Boston, MA)
- …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 ...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Humana (Boston, MA)
- …diverse scope and complexity ranging from moderate to substantial. The Associate Director , Data Quality/Integrity will lead and manage the HEDIS Supplemental Data ... metrics, documentation, quality controls, reporting, and exceptional delivery. The Associate Director will be responsible for ensuring the team lives Humana's… more
- Takeda Pharmaceuticals (Boston, MA)
- …Biostatistics, Global Emerging Markets (GEM; eg, China), Project Leadership, Finance, Corporate Communications and Business Development + Develop and manage strong ... LOC level Decision-making and Autonomy + Responsibility in line with Associate Director level position; independently lead HE projects and support the Global Health… more
- Evolent (Boston, MA)
- …**What You'll Be Doing:** Seeking a detail-oriented **Clinical Rules Management, Associate Director ** who will play a critical role in ensuring the accuracy and ... Lead the evaluation of clinical processes in collaboration with other clinical corporate , division, and facility teams to facilitate process redesign and guide… more
- Fresenius Medical Center (Waltham, MA)
- …+ Ensuring appropriate internal controls, timeliness, accuracy, and adherence to Corporate and governmental policy is maintained. + Ensuring that patient accounts ... accuracy. + Overseeing the monthly close process of the Advantx and Medical Manager sub-systems and providing the accounting department with cash deposits, projected… 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
- WellSense (Boston, MA)
- …health insurance company serving members across Massachusetts and New Hampshire through Medicare , Individual and Family, and Medicaid plans. Founded 25 years ago as ... Boston Medical Center HealthNet Plan, we provide plans and services...circumstances. **Job Summary:** At the direction of the Senior Director of Behavioral Health Programs and Strategy, the Senior… more
- Tufts Medicine (Lowell, MA)
- …experience required or combination of at least one year of acute medical /surgical nursing experience and 2 years of home health experience required. **Preferred ... + Communicates regularly with Clinical Managers as well as with the Clinical Director when issues arise relative to clinical practice or other performance related… more
- Humana (Boston, MA)
- …The IT Infrastructure Procurement Category Manager will report directly into the Director of IT Infrastructure Procurement and will lead the development of category ... of commercial protection and to minimize risk to Humana. + Drive corporate compliance to the preferred-supplier program via end-user change management and… 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)- ... regarding the grievance/appeal. * Print, mail, and triage letters at the FH corporate office located at 10 Chestnut Street, Worcester, MA. * Identifying the need… 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
- 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