- Humana (Boston, MA)
- …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse ... scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
- Elevance Health (Woburn, MA)
- ** Medical Director - Commercial ** Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... able to work East Coast time zone hours.** The ** Medical Director ** will be responsible for utilization...will be responsible for utilization review case management for Commercial business in the New England (CT, ME, and… more
- Humana (Boston, MA)
- **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- Humana (Boston, MA)
- **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (Boston, MA)
- **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- Bayer (Boston, MA)
- …supporting HCPs and Office staff in navigating therapy Prior Authorizations (PAs), Medical Necessity documentation and therapy PA denial appeals . Develop ... + In depth understanding of Payer/PBM therapy approval requirements (Prior Authorization, Medical Necessity, Denial Appeals , Formulary coverage and payment for… more
- Takeda Pharmaceuticals (Boston, MA)
- …purpose and be empowered to deliver your best. Join Takeda as the Associate Director , Patient Services Operations out of our Cambridge, MA office. As the Associate ... Director , Patient Services Operations, you will lead the design,...Sales Leadership, Marketing, Contracts and Pricing, Legal, Compliance, Training, Medical and Scientific Affairs and Regulatory, along with relevant… more
- Beth Israel Lahey Health (Burlington, MA)
- …patients admitted to the Clinic Attending Physicians: Coordinates appropriate documentation Medical Director for /Managed Care, Physician Advisors Works ... patient admission status based on regulatory and reimbursement requirements of various commercial and government payers. Manages UM department in the context of… more