- Commonwealth Care Alliance (Boston, MA)
- 011230 CA-Provider Engagement & Performance Position Summary: The Director of Provider Relations leads the strategic vision and operational execution of provider ... network performance, and ensuring compliance with regulatory standards. The Director drives initiatives that enhance operational engagement, member access, provider… more
- Commonwealth Care Alliance (Boston, MA)
- …in improvement to promote the development of a high quality team .collaboration with the broader clinical organization. - Ensures that utilization management ... training, and performance monitoring and - Leads the Utilization Management team in managing and continuously improving UM program design, policies, procedures,… more
- 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 (Boston, MA)
- …performance improvement. The LTSS Program Manager reports to the Senior Director of Delegation Partnerships and Provider Engagement. The Provider Engagement ... team is responsible for building and maintaining relationships with...Experience (must have):** + 5+ years + Experience with Medicaid and Medicare products and programs + Experience or… 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...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Boston, MA)
- …to adapt and the courage to innovate **Additional Information** Reports to the Lead Medical Director - North Central Medicaid Markets. The Medical ... caring community and help us put health first** The Medical Director relies on medical ...Medical Directors will learn North Central region state Medicaid requirements (currently VA, KY, OH, IN, WI) and… 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 ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Humana (Boston, MA)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture** + **Knowledge and experience with national guidelines… more
- Humana (Boston, MA)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture + Knowledge and experience with national guidelines… more
- Beth Israel Lahey Health (Charlestown, MA)
- …facilities, physician groups, performance networks, and community partners. As part of the leadership team , the Director will assist the VP and AVP to integrate ... to the AVP of Revenue Finance and Analysis, the Director will lead a team of 4-5...Director will develop long- and short- term Medicare, Medicaid , and other government reimbursement revenue strategies, oversee preparation… more
