• 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 (06/27/25)
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  • Manager Utilization Management

    Beth Israel Lahey Health (Burlington, MA)
    …payers and Joint Commission regulations/guidelines/criteria related to Utilization Review . + Well-developed knowledge and skills in medical necessity, ... collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities… more
    Beth Israel Lahey Health (06/06/25)
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  • Manager, Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    …The Manager, Utilization Management reports to the Director of Utilization Management * Oversees clinical decision review for services requiring prior ... staff, including nurse reviewers and support personnel. * Act as liaison with medical director , provider relations, case management and quality teams to support… more
    Commonwealth Care Alliance (05/21/25)
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  • Medical Director , MSK Surgery

    Evolent (Boston, MA)
    …new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as assigned mentor as ... Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a...Provides medical direction to the support services review process. Responsible for the quality of utilization… more
    Evolent (05/20/25)
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  • 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)
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  • Medical Director - Florida

    Humana (Boston, MA)
    …how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to 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 (07/29/25)
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  • Medical Director - South Carolina SE…

    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 (07/22/25)
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  • 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 (07/02/25)
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  • 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 (08/03/25)
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  • Field Medical Director , MSK (Spine)…

    Evolent (Boston, MA)
    …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
    Evolent (07/02/25)
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