- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Director , Inpatient Utilization Management ( UM ), leads and manages all utilization management ( UM ) functions for ... designed to support the administrative functions. This role works closely with Medical Directors, and the Vice President of Utilization Management to develop and… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- … leaders for decision making + Apply their clinical knowledge when assessing/auditing medical records and UM letters against medical necessity criteria ... + Accurately plan and scope projects; keep project leads, senior consultants, and Director informed of key...skills and understanding of CMS Part C guidance including UM operational procedures, and CMS guidance including coverage and… more