- Humana (Providence, RI)
- **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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Providence, RI)
- …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 problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- Elevance Health (Smithfield, RI)
- …the afternoons. Candidates must be able to work Eastern Time Zone hours. The ** Medicare Medical Director ** is responsible for the administration of physical ... ** Medical Director - Medicare (Part-time)**...gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status… more
- Humana (Providence, RI)
- …a part of 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...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Centene Corporation (Providence, RI)
- … Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace ... Payment Initiatives (VBP) will support the expansion and performance of Medicare -focused VBP arrangements across New York, including Medicare Advantage… more
- CVS Health (Providence, RI)
- …We are looking for a Principal Data Scientist to join our Aetna Medicare (STARS Portfolio) team at CVS Health. This high-level individual contributor will partner ... closely with the Executive Director of Aetna STARS Analytics to drive hands on...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- Humana (Providence, RI)
- **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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Providence, RI)
- …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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Providence, RI)
- **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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Evolent (Providence, RI)
- …business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical ... questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Providence, RI)
- …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. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Providence, RI)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Providence, RI)
- …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 ... recorded in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Evolent (Providence, RI)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director you will be a key member of the utilization management team. ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Evolent (Providence, RI)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... in Cardiology** (with Cardiology training and clinical experience). + **Unrestricted medical license** in the state of residence and willingness to obtain… more
- Hartford HealthCare (Norwich, CT)
- …become part of Connecticut's most comprehensive healthcare network. Position Summary: The Director of Care Coordination is responsible for leading a team of clinical ... oversight for the overall operations of the Care Coordination department. The Director is responsible for the development and implementation of the case management… more
- Humana (Providence, RI)
- …experience for our associates, members and providers. As the Resolution Team Operations Director ( Director , Grievance and Appeals), you will be accountable for ... starting your FIRST day of employment. Benefits include: + Medical Benefits + Dental Benefits + Vision Benefits +...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Prime Therapeutics (Providence, RI)
- …and drives every decision we make. **Job Posting Title** Trade Client Relations Director - Remote **Job Description** The Trade Client Relations Director is ... responsible for the analysis, modeling and delivery of innovative pharmacy and medical rebate strategies and cost saving solutions to Prime's clients to ensure Prime… more
- Humana (Providence, RI)
- …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
- Humana (Providence, RI)
- …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