Top 8833 Senior process Jobs in Framingham, Ma

Medical Director
WellSense Health Plan —Boston, MA
- $173,000 - $250,000 a year
- Full-time
- Background check
- Medicine
- Office
- Health insurance
- Dental insurance
Senior Interior Designer / Project Manager
Elms Interior Design —Boston, MA
- $75,000 - $125,000 a year
- Full-time
- Microsoft Word
- AutoCAD
- Microsoft Excel
- Health insurance
- Dental insurance
Quick Apply
R&D Manager – Insulin Pump
Dyme Medical —Marlborough, MA
- $140,000 - $160,000 a year
- Full-time
- Bachelor's degree
- In-person
- Senior level
- Health insurance
- Dental insurance
Quick Apply
Head of Sales and Marketing
Stellar Industries Corp. —Millbury, MA
- $125,000 - $205,000 a year
- Full-time
- 5 years
- Engineering
- Business Administration
- Disability insurance
- Health insurance
Quick Apply
Medical Dosimetrist (Senior/Staff)
Boston Medical Center —Boston, MA
- $112,000 - $162,500 a year
- Full-time
- Background check
- Anatomy knowledge
- Hospital
- Health insurance
- Dental insurance
Quick Apply
Controller
The Confidential Search Company —Boston, MA
- Up to $175,000 a year
- Full-time
- Microsoft Word
- Background check
- Microsoft Excel
- Disability insurance
- Health insurance
Quick Apply
Senior Program Manager
Autonodyne LLC —Boston, MA
- $150,000 - $205,000 a year
- Full-time
- Hybrid work
- Computer Science
- 5 years
- Office
- Health savings account
- Health insurance
Quick Apply
Senior Product Manager
Lifetime Brands —Medford, MA
- $85,000 - $100,000 a year
- Full-time
- Hybrid work
- Sales
- Office
- Bachelor's degree
- AD&D insurance
- Paid holidays
Quick Apply
Head of Administration and Finance
Stellar Industries Corp. —Millbury, MA
- $137,000 - $191,000 a year
- Full-time
- 7 years
- Office
- Bachelor's degree
- Disability insurance
- Health insurance
Quick Apply
Junior Associate Attorney - Family Law
Callahan, Inman & Bonzagni, P.C. —Westborough, MA
- $80,000 - $110,000 a year
- Full-time
- Writing skills
- Organizational skills
- In-person
- Paid training
- Health insurance
Quick Apply
Vice President, Strategic Sales - East (Remote)
CrowdStrike —Massachusetts
- $200,000 - $340,000 a year
- Full-time
- Remote
- 5 years
- Travel
- Recruiting
- Paid holidays
- Parental leave
Senior Network Engineer
Astrion —Hanscom AFB, MA
- $165,000 - $185,000 a year
- Full-time
- Engineering
- 11+ years
- Office
Plastics Engineer
PMM - America's Technology Molder —Hudson, MA
- $110,000 - $130,000 a year
- Full-time
- Engineering
- ERP systems
- Organizational skills
- AD&D insurance
- Disability insurance
Quick Apply
Associate Executive Director - Corporate Compliance Officer
North Charles Mental Health Research and Training Foundation, Inc —Cambridge, MA
- $73,000 - $80,000 a year
- Full-time
- HIPAA
- Office
- Master's degree
- Health savings account
- Health insurance
Quick Apply
Per Diem Inpatient Physical Therapist
Boston Medical Center —Boston, MA
- Part-time
- Background check
- CPR Certification
- High school
Quick Apply
Senior HR Generalist
Web Industries Inc —Marlborough, MA
- $70,000 - $80,000 a year
- Full-time
- Hybrid work
- Office
- Recruiting
- Organizational skills
- Employee stock ownership plan
Senior Mechanical Engineer
Manta Product Development —Cambridge, MA
- $100,000 - $200,000 a year
- Email
- Customer service
- Bachelor of Science
- Office
- Health insurance
- Dental insurance
Quick Apply
Chief Medical Officer MelroseWakefield Health Care
MelroseWakefield Healthcare —Melrose, MA
- $385,000 - $425,000 a year
- Full-time
- Medicine
- PALS Certification
- BC/BE
Senior Fire Protection Engineer
VeroSkills —Sudbury, MA
- $175,000 - $215,000 a year
- Full-time
- Management
- Construction site
- Engineering
Quick Apply
Senior Loan Officer
The Housing Partnership Network —Boston, MA
- $100,000 - $115,000 a year
- Full-time
- Mid-level
- Travel
- 2 years
- Health savings account
- Paid holidays
Quick Apply

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senior process jobs near framingham, ma

Medical Director

WellSense Health Plan -
Boston, MA

Apply Now

Job Details

Full-time
$173,000 - $250,000 a year

Benefits

Health insurance
Dental insurance
Flexible spending account
Paid time off
Vision insurance
403(b)
Opportunities for advancement

Qualifications

Managed care organization experience
Medical License

Full Job Description

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Medical Director will report to the Senior Medical Director of Utilization Management, Member Appeals & Grievances, and Medical Policy (Senior Medical Director of Utilization Management) and support the staff of the Office of Clinical Affairs in the areas of medical management daily medical necessity reviews, evaluation of medical policy, utilization trend management, quality, appeals and grievances, and pharmacy reviews.

Our Investment in You:

Full-time remote work

Competitive salaries

Excellent benefits

Key Functions/Responsibilities:

Provides clinical case review, consultation and oversight for all utilization management activities in a fashion that is compliant with all federal, state, and NCQA requirements

Conducts review of prior authorizations, concurrent reviews and retrospective medical necessity reviews that do not meet standard criteria and determines coverage

Works with the Senior Medical Director of Utilization Management to identify appropriate use of InterQual criteria and Medical Policy

Works with the Senior Medical Director to ensure consistent medical decision making for all physician reviewers, including the contracted physicians

Conducts clinical review of appeals and grievances in a fashion that is compliant with all federal, state and NCQA requirements

Develops and supports clinical initiatives to support department quality improvement and utilization management goals

Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment

Collaborates with hospital physicians, medical directors, primary care physicians and nurse case managers in daily activities and initiatives to improve the health of the population, the quality and experience of care our members receive, and lower the overall cost of care at the population level

Participates in and chairs clinical committees as assigned by the Senior Medical Director of Utilization Management

Supports quality, and pharmacy committees and activities

Provides input to the strategic planning process for the Office of Clinical Affairs as requested

Represents the Chief Medical Officer or Senior Medical Directors in Massachusetts, New Hampshire and other locations as requested

Supervision Exercised:

Indirect technical direction is provided to the organization

Supervision Received:

General direction is received weekly

Qualifications:

Education:

Graduate as a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) from an accredited allopathic or osteopathic medical school

Experience:

8-10+ years of related experience is required including a minimum of 5 years direct clinical experience and a minimum of 3 years experience in medical management in a managed care setting

Preferred/Desirable:

Preference for those with Board Certification in the following:

Internal Medicine

Internal Medicine-Pediatrics (Med Peds)

Family Medicine

Emergency Medicine

Certification or Conditions of Employment:

Pre-employment background check

Active or lifetime board certification in recognized medical specialty of the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)

Current unrestricted licensure as an MD or DO in Massachusetts and New Hampshire is required, or ability to obtain in a reasonable timeframe

Current unrestricted licensure as an MD in Massachusetts or New Hampshire is preferred

No restriction on participation in Medicare or Medicaid programs

Competencies, Skills, and Attributes:

Excellent demonstrated clinical skills and knowledge

Excellent written and verbal communication skills.

Comprehensive knowledge of accrediting organizations such as NCQA.

Comprehensive knowledge of InterQual protocols, HEDIS, and other quality measures.

Knowledge of Medicare and state Medicaid regulations, guidelines, and standards.

Proven leadership skills and relationship building.

Knowledge of managed care principles and processes.

Ability to work independently with intermittent supervision.

Adhere to appropriate turn-around-times and deadlines while maintain results of high quality and reliability.

Working Conditions and Physical Effort:

Work is normally performed in a typical remote interior/office work environment

No or very limited physical effort required. No or very limited exposure to physical risk

Ability to travel to locations within New Hampshire and Massachusetts

Regular and reliable attendance is an essential function of the position

Compensation Range

$173,000 - $250,000

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note: This range is based on Boston-area data, and is subject to modification based on geographic location.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

Apply Now

Refine Your Search

senior process jobs in framingham, ma

Medical Director

Senior Interior Designer / Project Manager

R&D Manager – Insulin Pump

Head of Sales and Marketing

Medical Dosimetrist (Senior/Staff)

Controller

Senior Program Manager

Senior Product Manager

Head of Administration and Finance

Junior Associate Attorney - Family Law

Vice President, Strategic Sales - East (Remote)

Senior Network Engineer

Plastics Engineer

Associate Executive Director - Corporate Compliance Officer

Per Diem Inpatient Physical Therapist

Senior HR Generalist

Senior Mechanical Engineer

Chief Medical Officer MelroseWakefield Health Care

Senior Fire Protection Engineer

Senior Loan Officer

I want to receive the latest job alert for senior process in framingham, ma

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