• RN Director , Utilization Management…

    Fallon Health (Worcester, MA)
    …monthly meeting, and TruCare Insights/upgrade meetings. + Represents the Vice President and Senior Medical Director of Clinical Management at internal and ... purpose:** With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief ...Utilization Management. + Works with VP/ Medical Director to set agenda related to UM … more
    Fallon Health (12/14/25)
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  • Physician Reviewer (Physician Review Unit)

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …in peer-to-peer outreach with treating providers, as appropriate. At the request of the Senior Medical Director of the Physician Review Unit (PRU), the ... is appropriate, as determined by plan benefit design, plan riders, and medical necessity criteria. In making coverage decisions regarding level of care, benefit… more
    Blue Cross Blue Shield of Massachusetts (12/10/25)
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