- Humana (Boston, MA)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... in accordance with Medicare and Humana policy. **Please note that this Medical Director position is non-benefitted, and compensated hourly * **Use your… 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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Merck (Boston, MA)
- …with HSO MADs + Serves as a resource for the PM MAD-HSO Team Lead, HSO Executive Director Medical Affairs, and other members of US Medical Affairs on other ... **Job Description** + The Precision Medicine - Medical Affairs Director - Health Systems...research \#eligibleforERP **Required Skills:** Benefit Programs, Clinical Data, Clinical Pharmacy , Clinical Studies, Medical Affairs, Medical… more
- Commonwealth Care Alliance (Boston, MA)
- …and long term services and supports. Works closely with delegated entities, pharmacy , dental and other vendors to assure integration, oversight, and efficiency of ... and quality improvement. * Minimum five (5) years of clinical experience in medical or behavioral health care delivery Required Knowledge, Skills & Abilities: * … more
- Takeda Pharmaceuticals (Boston, MA)
- …and be empowered to deliver your best. In this highly visible role, the Sr. Director will lead the strategic and analytic aspects of the US Oncology BU's (US OBU's) ... access analytics, and lead the newly formed health economics function. The Sr Director will develop the analytic aspects of the US OBU's commercial and government… more
- Beth Israel Lahey Health (Boston, MA)
- …assistance program coordinators. This individual will also work closely with the director of pharmacy shared services on various projects, implementations and ... accuracy. (essential) 9. Monitors situations for fraud, waste, and abuse of Medicare /Medicaid benefits and reinforces HIPAA and PHI protocols. (essential) 10. Has… more
- CenterWell (Pittsfield, MA)
- …audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers ... of care and outcome planning. + Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals. +… more
- State of Massachusetts (Tewksbury, MA)
- …Department of Clinical Social Work, Hathorne Units, Joint Commission, Centers for Medicare , and Medicaid Services (CMS) / Health Care Finance Administration (HCFA) ... * Works on assigned committees as instructed by the Director of Clinical Social Work. * Produces reports and/or...* Proficiency in Microsoft Office * Proficiency in Electronic Medical Record systems * Given the population served, bilingual… more
- Takeda Pharmaceuticals (Cambridge, MA)
- … pharmacy and distributor agreements, including agreements with: commercial and Medicare payers, pharmacy benefit managers (PBMs), Oncology GPOs, the ... the role:** As Counsel, Market Access, at the senior director level, you will be responsible for providing day-to-day...US based employees may be eligible to participate in medical , dental, vision insurance, a 401(k) plan and company… more
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