• Utilization Review Medical…

    Commonwealth Care Alliance (Boston, MA)
    … Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for providing leadership ... Serve as the lead for CCA's Utilization Review functions working closely with other medical ...preferred. + Primary care discipline, prior experience as Associate Medical Director (or equivalent) or physician reviewer… more
    Commonwealth Care Alliance (09/05/25)
    - Related Jobs

  • RN System Director Utilization…

    Tufts Medicine (Burlington, MA)
    …coordinates the design, development, implementation, and monitoring of the organization's utilization review functions. The position establishes the department's ... the utilization of resources, coordination of care across the continuum and utilization review and management. The position develops and leads the … more
    Tufts Medicine (09/11/25)
    - Related Jobs

  • National Accounts Medical Director

    Elevance Health (Woburn, MA)
    …The medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical relevance to ... day clinical responsibilities means that the medical director is directly involved in Utilization Management...state or territory of the United States when conducting utilization review or an appeals consideration and… more
    Elevance Health (08/27/25)
    - Related Jobs

  • Field Medical Director…

    Evolent (Boston, MA)
    …non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National...process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
    Evolent (07/30/25)
    - Related Jobs

  • Medical Director - Southeast Region

    Humana (Boston, MA)
    …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... management. + Utilization management experience in a medical management review organization, such as Medicare...on size of region or line of business. The Medical Director conducts Utilization Management… more
    Humana (09/10/25)
    - Related Jobs

  • Field Medical Director , Cardiology

    Evolent (Boston, MA)
    …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
    Evolent (08/15/25)
    - Related Jobs

  • Field Medical Director - Vascular…

    Evolent (Boston, MA)
    …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
    Evolent (08/28/25)
    - Related Jobs

  • Behavioral Health Medical Director…

    Humana (Boston, MA)
    …care management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and ... operations team and healthcare organization. The Medical Director 's work includes computer based review of...management + Utilization management experience in a medical management review organization, such as Medicare… more
    Humana (08/09/25)
    - Related Jobs

  • Medical Director - Acute Rehab Team

    Humana (Boston, MA)
    …to operationalize this knowledge in their daily work specifically for DSNP. The Medical Director 's work includes computer-based review of moderately complex ... providers. + Utilization management experience in a medical management review organization, such as Medicare...on size of region or line of business. The Medical Director conducts Utilization Management… more
    Humana (09/11/25)
    - Related Jobs

  • Medical Director - Northeast 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 ... caring community and help us put health first** The Medical Director relies on medical ...management. + Utilization management experience in a medical management review organization, such as Medicare… more
    Humana (07/25/25)
    - Related Jobs