- Commonwealth Care Alliance (Boston, MA)
- …Knowledge, Skills & Abilities (must have): - Expertise in managing utilization review processes including prior authorization, concurrent and retrospective ... is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting… more
- Commonwealth Care Alliance (Boston, MA)
- …for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has ... 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Jobleads-US (Chicago, IL)
- …a voice for Provider needs across the company Performance Management Track and review provider KPIs ( Utilization , NPS, retention, etc) Design incentive programs ... by a trauma surgeon and a former SpotHero executive, our team blends deep medical expertise with startup execution. Pinch is building the infrastructure to support a… more
- MVP Health Care (Rochester, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a Medical Director, Behavioral Health Children's Services , to join #TeamMVP. If you ... be in a clinical setting). Previous experience as a medical director in a managed care/health plan is desirable....knowledge of NYS child serving systems. Experience with critical review in clinical scenarios is desirable. Knowledge of and… more
- Terumo Medical Corporation (Elkton, MD)
- …Oct 26, 2025 Req ID: 5036 Location: Elkton, MD, US Company: Terumo Medical Corporation Department: TMC Information Technology Terumo Medical Corporation (TMC) ... develops, manufactures, and markets a complete, solutions-based portfolio of high-quality medical devices used in a broad range of applications for numerous areas of… more
- Commonwealth Care Alliance (Boston, MA)
- …success. + Conduct regular provider meetings (virtual and in-person) to review performance, discuss program updates, and address operational challenges. + Represent ... + Lead the monitoring and analysis of provider performance using utilization , quality, and member experience metrics. + Collaborate with Business Intelligence,… more
- Commonwealth Care Alliance (Springfield, MA)
- …panel of CCA's patients incorporates the care of individuals with significant medical , behavioral, and social complexities that require intensive care management and ... care delivery and care coordination for the most complex medical and behavioral health patients. The CHW participates in...the outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment and closing gaps in care… more
- Eisai, Inc (Boston, MA)
- At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides to patients, their families, and caregivers is Eisai's human health care ... Executives to work with downstream regional payer accounts of the national payers. Review and analyze applicable data to make informed decisions on regional payer… more
- Houston Methodist Sugar Land Hospital (Sugar Land, TX)
- …for an expanded clinical role that may include responsibility for proactive review of patient profiles, participation in basic clinical functions such as discharge ... in any or all areas of the department to include processing orders, therapy review , and education to patients and other members of the direct patient care team.… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …(Pricing, Contracting, Operations and Reimbursement), HEOR, Marketing, Commercial Sales, Medical Affairs, and Legal & Compliance. External relationships include ... their placement in the treatment continuum as well as appropriate utilization and treatment guidelines Proactively leverages detailed knowledge of all applicable… more
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