• Utilization Management…

    Humana (Boston, MA)
    …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
    Humana (01/10/26)
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  • Utilization Management Nurse

    CenterWell (Boston, MA)
    …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous...and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral … more
    CenterWell (01/16/26)
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  • Behavioral Health - Care Manager II

    Elevance Health (Woburn, MA)
    …required. **Preferred Skills, Capabilities, and Experiences:** + Utilization Management experience strongly preferred. + Inpatient mental health experience ... ** Behavioral Health - Care Manager II**...** Behavioral Health - Care Manager II** **Location** : _Virtual:_...is licensed staff supervision. + Previous experience in case management / utilization management with a broad… more
    Elevance Health (01/16/26)
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  • Behavioral Health Medical Director

    Humana (Boston, MA)
    …clinical services . Experience in utilization management review and case management in a health plan setting . No current sanction from Federal or ... part of our caring community and help us put health first** The Behavioral Health ...a focus on collaborative business relationships, value-based care, population health , or disease or care management +… more
    Humana (01/13/26)
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  • Physician Reviewer ( Behavioral…

    Blue Cross Blue Shield of Massachusetts (Boston, MA)
    …Active clinical practice in order to participate in panel appeals + Experience in Utilization Management in a managed-care environment (as a clinician or in ... to evaluate clinical service requests + Practice anticipatory case management for members whose cases come for review, in...as the highest in member satisfaction among Massachusetts commercial health plans by JD Power , Blue Cross Blue… more
    Blue Cross Blue Shield of Massachusetts (11/25/25)
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  • Clinical Social Worker LICSW - Pediatrics:…

    Tufts Medicine (Boston, MA)
    …may impede progress. Makes recommendations to the team regarding patient/family care and management . Assists health care team to assist patient/family level of ... **Clinical Social Worker LICSW - Pediatrics: Developmental/ Behavioral Pediatrics - Boston - Sign-on Bonus Eligible** **Job Profile** **Summary** ​This role focuses… more
    Tufts Medicine (01/16/26)
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  • Health Outcomes Pharmacist

    Highmark Health (Boston, MA)
    …drug policy, therapeutic alternatives, medication adherence strategies, Medication Therapy Management , utilization management , immunizations, specialty ... Pharmacy **Substitutions** + None **Preferred** + Master's Degree in Health Administration or Business or + Doctorate Degree in...+ Healthcare + Care Planning + Continuous Improvement + Utilization Management + Healthcare Management … more
    Highmark Health (01/17/26)
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  • Medical Director, Medical Management

    Highmark Health (Boston, MA)
    …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
    Highmark Health (11/21/25)
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  • Lead Clinical and Population Health Analyst…

    Highmark Health (Boston, MA)
    …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... decisions, ensuring alignment with the Quadruple Aim of Healthcare: lower per capita health care costs, improved outcomes and quality of care received, and optimal… more
    Highmark Health (12/31/25)
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  • Transplant Care Nurse (Remote)

    Highmark Health (Boston, MA)
    …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
    Highmark Health (01/10/26)
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