• Director of Utilization…

    Insight Global (Boston, MA)
    Job Description Insight Global is sourcing for a Utilization Management Director to join a not-for-profit community based healthcare organization within the ... federal, state, and local regulatory guidelines. -Support the development of utilization management policy initiatives. -Support the development and… more
    Insight Global (07/12/25)
    - Related Jobs

  • Manager, Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    …of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager, Utilization Management reports to the Director of ... & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the… more
    Commonwealth Care Alliance (05/21/25)
    - Related Jobs

  • Medical Director - South Carolina SE Region

    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 ... value based care, population health, or disease or care management . **Responsibilities** The Medical Director provides medical...with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (07/22/25)
    - Related Jobs

  • Medical Director - Gulf South

    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 (07/08/25)
    - Related Jobs

  • Medical Director - Mid West Region

    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 (05/14/25)
    - Related Jobs

  • 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)
    - Related Jobs

  • Manager Utilization Management

    Beth Israel Lahey Health (Burlington, MA)
    …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... compliance reviews as needed. + Continuously monitors regulatory requirements for Utilization Management . + Attends Mandatory Education programs required by… more
    Beth Israel Lahey Health (06/06/25)
    - Related Jobs

  • 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)
    - Related Jobs

  • 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)
    - Related Jobs

  • 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 (04/30/25)
    - Related Jobs