- 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
- 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
- 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 (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 (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
- 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
- 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
- Brockton Hospital (Brockton, MA)
- PURPOSE OF POSITION: The Director of Case Management is responsible for planning, directing, and managing of the activities of the Case Management Program ... solves problems, referring exceptional issues to Vice President. The Director of Case Management is responsible for...enhances the quality of patient care while optimizing resource utilization . Provides training to staff on case management… more
- 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
- 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