- 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 (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 ... 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
- 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
- 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
- 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 actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Takeda Pharmaceuticals (Boston, MA)
- …inspire you and empower you to shine? Join us as a PV Risk Management Scientist/Associate Director . At Takeda, we are transforming the pharmaceutical industry ... for excellence in everything we do. As an Associate Director / PV Risk Management Scientist, being part...controlled access program + Provide guidance regarding tracking risk management commitments including utilization of a tracking… more
- Evolent (Boston, MA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... cases. you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National … more