• Senior Accreditation…

    Humana (Montpelier, VT)
    …Degree or BSN degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + ... help us put health first** We are seeking a Senior Accreditation Professional who will work in...on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming … more
    Humana (05/09/25)
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  • Field Medical Director, Pain Management

    Evolent (Montpelier, VT)
    …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... , 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
    Evolent (04/12/25)
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  • BCBA-D ABA UM Reviewer

    Humana (Montpelier, VT)
    …a part of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work… more
    Humana (05/07/25)
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  • Field Medical Director, Interventional Cardiology…

    Evolent (Montpelier, VT)
    …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to… more
    Evolent (04/30/25)
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  • Field Medical Director, Cardiology

    Evolent (Montpelier, VT)
    …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... Director 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
    Evolent (02/14/25)
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  • Field Medical Director, Radiology (Endocrinology)

    Evolent (Montpelier, VT)
    …Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
    Evolent (05/03/25)
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  • Clinical Letter Writer - UM & Specialty Experience…

    Evolent (Montpelier, VT)
    …members and providers + Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director. + Appropriately ... policies + Creates adverse determination notifications that meet all accreditation , State, and Federal criteria + Uses Plain Language...identifies potential cases for Care Management programs + Communicates appropriate information to other staff… more
    Evolent (04/25/25)
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