• Manager , Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    …Director of Utilization Management * Oversees clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... (must have): * Expertise in managing utilization review processes including prior authorization , concurrent and retrospective reviews * Demonstrated ability… more
    Commonwealth Care Alliance (05/21/25)
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  • Medical Policy Program Manager

    Commonwealth Care Alliance (Boston, MA)
    …in the process for evaluating the effectiveness of company medical policies and prior authorization programs and supports the evaluation of payment policies. ... in the annual evaluation of the effectiveness of company medical policies and prior authorization program. + Support the payment policy and claims teams… more
    Commonwealth Care Alliance (05/31/25)
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  • Manager , Medical Policy

    Commonwealth Care Alliance (Boston, MA)
    …the process for evaluating the effectiveness of company medical policies and prior authorization programs and supports the evaluation of payment policies. ... 011200 CCA-Central Clin Ops Leadership **Position Summary:** The Manager , Medical Policy reports to the Director of...evaluation of the effectiveness of company medical policies and prior authorization program. + Support the payment… more
    Commonwealth Care Alliance (05/31/25)
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  • Mental Health Parity Clinical Analyst (Remote)

    WTW (Boston, MA)
    …Third Party Administrator, Regulatory Agency, Legal/Compliance Firm, or insurance company + US Registered Nurse or LCSW with active licensed preferred + Health ... utilization/case management processes, network management, credentialing, quality management, pharmacy prior - authorization processes and health plan operations +… more
    WTW (07/15/25)
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  • Breast Nurse Coordinator--Hem-Onc, 40 hrs,…

    Beth Israel Lahey Health (Boston, MA)
    …degree in Nursing required. Bachelor's degree in Nursing preferred. 2. License Registered Nurse required., and Certificate 1 Basic Life Support required. ... for patients from referral/consultation to discharge /follow up. Assists with pre- authorization process. 2. Serves as contact and facilitator to receive consults… more
    Beth Israel Lahey Health (07/13/25)
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  • Nurse Utilization Management Reviewer

    Commonwealth Care Alliance (Boston, MA)
    …Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... **Required Knowledge, Skills & Abilities (must have):** + Experience with prior authorization and retrospective reviews + Proficiency reviewing clinical/medical… more
    Commonwealth Care Alliance (05/23/25)
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