- Harbor Health Services, Inc. (Mattapan, MA)
- …request of utilization or finance department. Works with UM RNs and Senior Medical Director to deny claims when appropriate. Attends IDT meetings on routine ... and cares for more than 580 participants. We are currently seeking a Director of Utilization Management & Quality Programs. Harbor Health offers an excellent,… more
- 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)
- …satisfaction and member access to care. Reporting to the Senior , Director of Delegation Partnerships., the Senior Provider Relations Account Manager will: + ... + **Operational Excellence:** + Collaborate with cross-functional teams (eg, Claims , Credentialing, Clinical Care Management, Member Services, Provider Services,… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary** The Program Manager, in collaboration with the Sr Director of Delegation Partnerships and Performance, is responsible for advancing provider ... performance frameworks and value-based care principles. + Working knowledge of claims data, quality measurement, and performance incentive methodologies. + Excellent… more
- CSL Behring (Waltham, MA)
- We are currently recruiting for an experienced, dynamic and visionary Senior Director of Cardiovascular & Renal Global Commercial Development to join our team. This ... driving early product strategy, Target Product Profiles (TPPs), Target Product Claims (TPCs), Stage-Gate Preparation, and Life Cycle Management (LCM) Planning and… more
- Thom Child and Family Services (Norwood, MA)
- …transmission guidelines and dates. Bills, posts payments and follows up on claims for services to private health insurers, MassHealth, and the Massachusetts ... in TC. Designs special reports from TBR upon request of the Program Director . Updates billing software and data as needed. Communicates with Program Director… more
- Ryder System (Boston, MA)
- …clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **Summary** The Director Claims directs activities within the General and ... third-party provider relationships (including consultants, legal counsel, insurers, and external claims administrators). The Director manages and oversees the… more
- Elevance Health (Woburn, MA)
- ** Director I, Digital Claims Operations (Dir I Digital Ops)** Location: This role requires associates to be in-office **3 days per week** , fostering ... resides within a commutable distance from an office._ The ** Director I, Digital Claims Operations** will lead key operational functions within Claims… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex clinical… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex clinical… more
