- Humana (Boston, MA)
- …organization focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with ... 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… more
- CVS Health (Wellesley, MA)
- …every day. **Position Summary:** CVS Health is seeking a strategic and collaborative Executive Director to lead our Account & Delivery Management team. This role ... Resource Management ** + Oversee project workflow, resourcing plans, and utilization reporting to ensure efficiency and transparency. + Identify and implement… more
- Humana (Boston, MA)
- …organization focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with ... of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The Corporate… more
- CVS Health (Boston, MA)
- …anywhere in the US.** Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from home. The ... Medical Director (Spine) will be a Subject...responses to members and providers. Leads all aspects of utilization review/quality assurance, directing case management Provides… more
- Evolent (Boston, MA)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... **Performance Suite risk arrangements with payers and strategic utilization management initiatives.** This is an opportunity for a **Cardiologist** to shape… more
- East Boston Neighborhood Health Center (MA)
- …policies, procedures, and patient education materials in collaboration with the Medical Director (s). 3.Facilitates in collaboration with the BH Leadership ... training team as indicated. 4.In collaboration with the BH Medical Director , designs and implements the BHC...Specialty, and all other clinical programs assigned. 18.Provides programmatic management and oversight of access and utilization … more
- Sanofi Group (Cambridge, MA)
- …of short- and long-term business plans that will optimize appropriate coverage, coding, Utilization Management , payment of and patient access to Sanofi products. ... Director will demonstrate strong relationships with Trade/Industry Relations, Medical and Pharmacy Directors (clinical and administrative), Case Managers, … more
- Merck (Boston, MA)
- **Job Description** **Role Summary:** The Sr. Global Director Medical Affairs (GDMA) is responsible for supporting the execution of scientific & medical ... headquarters submission (ex-USA). + Manages programs (patient support, educational or risk management ) to support appropriate and safe utilization of Our Company… more
- Highmark Health (Boston, MA)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member...DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community… more
- Tufts Medicine (Burlington, MA)
- …in cooperation with multiple revenue cycle and hospital departments, such as Coding, Utilization Management (UM), Case Management , Quality and Physician ... is responsible for CDI program strategy and oversight. The Director will partner with the Senior Director ,...organize, implement, and evaluate the CDI program. This includes management of case mix index (CMI), length of stay… more