• RN Director , Utilization Management…

    Fallon Health (Worcester, MA)
    …Management and SVP/Chief Medical Officer will provide strategic leadership and oversight responsibility for the clinical and operational utilization management ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)-… more
    Fallon Health (12/14/25)
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  • Director of Home Health Authorizations,…

    CenterWell (Boston, MA)
    …paths, and performance accountability across a complex, multi-site organization. ** Operational Oversight ** * Direct day-to-day authorization, eligibility ... caring community and help us put health first** A ** Director of Authorizations & Eligibility** is a senior revenue...a senior revenue cycle leader responsible for the strategic oversight , operational execution, and continuous improvement of… more
    CenterWell (01/08/26)
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  • Clinical Account Director - Remote

    Prime Therapeutics (Boston, MA)
    …build the future of pharmacy with us. **Job Posting Title** Clinical Account Director - Remote **Job Description** The Clinical Account Director is responsible ... As the primary point of contact for their designated BCBS clients, the director promotes and recommends Prime standard offerings to meet client requirements and… more
    Prime Therapeutics (12/07/25)
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  • Medical Director , Medical Policy

    Highmark Health (Boston, MA)
    …**JOB SUMMARY** This role supports the Medical Policy team by bringing medical director level expertise, experience and knowledge to the team. They support the ... full-cycle ownership of commercial and Medicare Advantage medical policies, both developed internally and by...research, engagement of clinical and non-clinical team members for operational guidelines. The incumbent must have an understanding of… more
    Highmark Health (12/24/25)
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  • Behavioral Health Services Regional Medical…

    Advocates (Framingham, MA)
    …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 assigned region. The...the Chief Medical Officer, is responsible for the development, oversight , and administration of medical services in the region.… more
    Advocates (11/15/25)
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  • Manager, Health Plan Provider Relations…

    Molina Healthcare (MA)
    …between Molina Healthcare and contracted provider network. In partnership with Director , manages and coordinates the Provider Services activities for the state ... for the daily operations of the department working collaboratively with other operational departments and functional business unit stakeholders to lead or support… more
    Molina Healthcare (01/09/26)
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  • Senior Hospice Care Manager, RN $10,000 Sign…

    Gentiva (Boston, MA)
    …Do you thrive in a leadership role that blends clinical excellence with strategic oversight ? If so, you could be the next Hospice Patient Care Manager Senior on ... Patient Care Manager, RN You Will:** * Report directly to the Executive Director or Administrator * Lead and support a high-performing hospice program, ensuring… more
    Gentiva (12/17/25)
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  • Revenue Integrity Senior Analyst - HMFP

    Beth Israel Lahey Health (Woburn, MA)
    …you're making a difference in people's lives.** Under the direction of the Director , Revenue Integrity and Coding at Harvard Medical Faculty Physicians (HMFP) at the ... the Revenue Integrity Senior Analyst contributes to Revenue Integrity and Coding oversight at the enterprise, which aims to maximize synergies across HMFP… more
    Beth Israel Lahey Health (10/30/25)
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  • Manager, Ancillary Provider Contracting

    Point32Health (Canton, MA)
    …+ Ability to understand the nuances of Tufts Health Plan's commercial and Medicare Preferred product lines and the unique operational and financial features ... allied contracts and will assist team members during negotiations by providing oversight and assistance with the negotiations of financial and legal terms. The… more
    Point32Health (12/13/25)
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  • Duals Performance Manager, Product strategy

    Point32Health (Canton, MA)
    …improvement recommendations based on analytic findings. Under the direction of the Director of Product Strategy, the Manager contributes to building presentations of ... a variety of domains including medical trend, financial and operational performance, member/provider experience, care management, network development and compliance… more
    Point32Health (12/03/25)
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