• Utilization Management…

    Elevance Health (Woburn, MA)
    ** Utilization Management Medical Director - NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of ... Alternate locations may be considered. The ** Medical Director ** will be responsible for utilization review case management for North Carolina Medicaid.… more
    Elevance Health (09/26/25)
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  • Field Medical Director…

    Evolent (Boston, MA)
    …setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional cardiology ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management … more
    Evolent (07/30/25)
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  • Medical Director - Claims…

    Humana (Boston, MA)
    … Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care received ... caring community and help us put health first** The Medical Director actively uses their medical...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
    Humana (09/17/25)
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  • RN Care Manager - Senior Care Options - Danvers,…

    Point32Health (MA)
    …and liaises with the interdisciplinary care team, to improve member outcomes (ie, Utilization Management , Medical Director , pharmacy, community health ... CM) will ensure that all members receive timely care management (CM) across the continuum, including transitions of care,...ability to facilitate a care plan which ensures quality medical care for the member. The RN CM works… more
    Point32Health (10/01/25)
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  • 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 an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
    Humana (10/03/25)
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  • 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 an ... healthcare providers, clinical group practice management . + Utilization management experience in a medical... management operational improvements, including those within the medical director area + Participate in call… more
    Humana (09/16/25)
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  • 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 in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
    Humana (07/25/25)
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  • RN System Director Utilization…

    Tufts Medicine (Burlington, MA)
    … review and management . The position develops and leads the Utilization Management operations, strategy and implementation of the Utilization ... of Science in Nursing (BSN). 2.Massachusetts RN Licensure. 3. Current certification in case/ utilization management (ACM, CCM, CMAC) 4. Seven (7) years of UM/Case… more
    Tufts Medicine (10/01/25)
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  • Director , Utilization…

    Commonwealth Care Alliance (Boston, MA)
    … Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term ... a high quality team.collaboration with the broader clinical organization. * Ensures that utilization management processes are integrated with care management … more
    Commonwealth Care Alliance (10/02/25)
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  • 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 ... UM staff, including nurse reviewers and support personnel. * Act as liaison with medical director , provider relations, case management and quality teams to… more
    Commonwealth Care Alliance (10/02/25)
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