• Medical Director - Medicare…

    Humana (Boston, MA)
    …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
    Humana (07/23/25)
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  • Medicare Grievances and Appeals…

    Humana (Boston, MA)
    …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
    Humana (06/18/25)
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  • Manager, Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    …staff, including nurse reviewers and support personnel. * Act as liaison with medical director , provider relations, case management and quality teams to support ... Management (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care… more
    Commonwealth Care Alliance (05/21/25)
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  • Research Administrator II - Department of Medicine…

    Tufts Medicine (Boston, MA)
    …clinical trial budgets with sponsors and assists with the completion of Medicare Coverage Analyses. 4. Keeps abreast of new and modified sponsor regulations ... of fiscal state of research program/laboratories and makes recommendations to PIs and director for planning purposes. 9. Meets regularly with director and PIs… more
    Tufts Medicine (07/14/25)
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