• Medical Director - National…

    Humana (Boston, MA)
    …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests ... for services. The Medical Director work assignments involve moderately complex...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
    Humana (09/12/25)
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  • Behavioral Health Medical Director…

    Humana (Boston, MA)
    …our caring community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. ... The Behavioral Health Medical Director work assignments involve moderately complex...Medicare Advantage and managed Medicaid + Experience with national guidelines such as MCG(R), ASAM or InterQual +… more
    Humana (08/09/25)
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  • Corporate Medical Director…

    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 (09/05/25)
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  • Medical Director - Medicare…

    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 (09/06/25)
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  • Medicare /Medicaid Claims Editing…

    Commonwealth Care Alliance (Boston, MA)
    …at this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding ... reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare ) + Medical Coding, Compliance, Payment Integrity and Analytics… more
    Commonwealth Care Alliance (08/26/25)
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  • Medical Director - OneHome

    Humana (Boston, MA)
    …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... health, SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services… more
    Humana (08/25/25)
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  • Medical Director - Acute Rehab Team

    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 ... to operationalize this knowledge in their daily work specifically for DSNP. The Medical Director 's work includes computer-based review of moderately complex to… more
    Humana (09/11/25)
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  • Medical Director - Northeast Region

    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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
    Humana (07/25/25)
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  • National Account Director

    Rhythm Pharmaceuticals (Boston, MA)
    …adapt, learn, and our tenacity to overcome barriers, together. Opportunity Overview The National Account Director (NAD) will be a field-based strategic leader ... Part D payers. The NAD will develop and maintain relationships with national and regional Medicare payers, third-party administrators (TPAs), PBMs, employers… more
    Rhythm Pharmaceuticals (07/31/25)
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  • Field Medical Director , Cardiology

    Evolent (Boston, MA)
    …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
    Evolent (08/15/25)
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