- Commonwealth Care Alliance (Boston, MA)
- …this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. ... that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for timely review and… more
- CVS Health (Boston, MA)
- …given to candidates residing in the eastern time zone._ **Position Summary** The Lead Director of Product Operations will assume full ownership of Mental Well ... and strategic alignment across the MWB portfolio. The Lead Director will lead post-implementation monitoring, drive cross-functional issue resolution, and… more
- Fallon Health (Worcester, MA)
- …be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the Elderly)- in ... of purpose:** With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief Medical Officer will provide strategic leadership and… more
- Commonwealth Care Alliance (Boston, MA)
- …against internal and regulatory benchmarks. * Ensure provider network compliance with CMS, state Medicaid agency, and NCQA standards. * Lead initiatives to ... operations , education, and performance improvement. The Provider Relations Director reports to the Sr Director of... and satisfaction. * Strong understanding of Medicare and Medicaid health plan operations , including regulatory and… more
- Option Care Health (Boston, MA)
- …Sales Director will work collaboratively with Option Care Health Operations to resolve customer service issues and ensure high-quality service and ongoing ... talent in healthcare. **Job Description Summary:** The Specialty Sales Director will develop and implement the Specialty business sales...Insurance, Medicare Part B & D, Fee for Service Medicaid , Managed Medicaid ) Due to state… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Associate Director of Cloud Infrastructure Operations is responsible for leading Humana's enterprise ... opportunity to lead Humana's transformation at the intersection of operations , technology, and AI innovation. The Associate Director...that leverage metrics, logs, and traces to provide holistic state of the cloud operations . + A… more
- Humana (Boston, MA)
- …part of our caring community and help us put health first** The Director , Business Systems Analysis leads the strategic advancement, optimization, and integration of ... systems and solutions that support healthcare provider operations . This role serves as a key liaison between business stakeholders, IT, and provider operations ,… more
- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** Director Enterprise Data Quality and Stewardship The Data Governance Director will be the ... needs and dynamics of different stakeholders. Some key responsibilities of the Director Enterprise Data Quality and Stewardship include (& not limited to): +… more
- Advocates (Framingham, MA)
- …to regional director and clinic directors in support of clinic operations to ensure the provision of high-quality care. + Provides clinical supervision, ... the ideas and contributions of our staff. The Behavioral Health Regional Medical Director (RMD) is a leadership and clinical role within Advocates' Behavioral Health… more
- Sumitomo Pharma (Boston, MA)
- …Pharma Co., Ltd., is a global pharmaceutical company based in Japan with operations in the US (Sumitomo Pharma America, Inc.), focused on addressing patient needs ... motivated, and experienced individual for the position of Associate Director , Market Access Engagement - Rare Disease, who will...a timely manner. This person will deliver product, disease state and resource education to payers and policymakers to… more