• Utilization Review Medical Director

    Commonwealth Care Alliance (Boston, MA)
    … will be responsible for providing leadership and subject matter expertise to our utilization management (UM) group. This role is a key role in helping ... other medical management team members. + Support the development of utilization management policy initiatives. + Support the development and implementation… more
    Commonwealth Care Alliance (06/27/25)
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  • Medical Director - National Medicare

    Humana (Boston, MA)
    … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (07/21/25)
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  • Director of Case Management - RN V

    State of Massachusetts (Boston, MA)
    …staff and hospital-wide teams./ * /Ensure timely and accurate dissemination of utilization management data across departments and maintain compliance with ... data for improvement opportunities./ * /Prepare statistical and narrative summaries on utilization and case management effectiveness for stakeholders./ * /Engage… more
    State of Massachusetts (07/24/25)
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  • Medical Director , MSK Surgery

    Evolent (Boston, MA)
    …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as ... for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with… more
    Evolent (05/20/25)
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  • Field Medical Director , Interventional…

    Evolent (Boston, MA)
    …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
    Evolent (07/30/25)
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  • Medical Director - South Central

    Humana (Boston, MA)
    … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (07/11/25)
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  • PV Risk Management Scientist/Associate…

    Takeda Pharmaceuticals (Boston, MA)
    …inspire you and empower you to shine? Join us as a PV Risk Management Scientist/Associate Director . At Takeda, we are transforming the pharmaceutical industry ... for excellence in everything we do. As an Associate Director / PV Risk Management Scientist, being part...controlled access program + Provide guidance regarding tracking risk management commitments including utilization of a tracking… more
    Takeda Pharmaceuticals (05/22/25)
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  • Regional Field Director , RNS Program…

    United Therapeutics (Boston, MA)
    …is innovative and inspiring where you can truly make a difference. The Regional Field Director , RNS Program Management serves as a director of all clinical ... the commercial non-promotional team. In addition, the Regional Field Director , RNS Program Management will: + Serve...initiation of a UT product, adverse effect mitigation, device utilization , and dosing upon request + Support the Clinical… more
    United Therapeutics (08/07/25)
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  • Field Medical Director -Vascular Surgery

    Evolent (Boston, MA)
    …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National … more
    Evolent (08/03/25)
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  • Field Medical Director , MSK (Spine)…

    Evolent (Boston, MA)
    …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... cases. you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National … more
    Evolent (07/02/25)
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