- Commonwealth Care Alliance (Boston, MA)
- …dental and other vendors to assure integration, oversight, and efficiency of UM processes and functions. - Ensures compliance with all contract requirements, state ... the CMO and VPMA to develop and advance the UM program and leads and organizes the ongoing evaluation...- Minimum five (5) years of clinical experience in medical or behavioral health care delivery Required Knowledge, Skills… more
- Commonwealth Care Alliance (Boston, MA)
- … staff, including nurse reviewers and support personnel. - Act as liaison with medical director , provider relations, case management and quality teams to support ... Management (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care… more
- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- Commonwealth Care Alliance (Boston, MA)
- …dental and other vendors to assure integration, oversight, and efficiency of UM processes and functions. * Ensures compliance with all contract requirements, state ... the CMO and VPMA to develop and advance the UM program and leads and organizes the ongoing evaluation...* Minimum five (5) years of clinical experience in medical or behavioral health care delivery Required Knowledge, Skills… more
- Evolent (Boston, MA)
- …Tasks are performed within the RN/LVN/LPN scope of practice, under Medical Director direction, using independent nursing judgement and decision-making, ... that do not meet established clinical criteria to the Medical Director . + Appropriately identifies and refers.... + Appropriately identifies and refers quality issues to UM Leadership. + Appropriately identifies potential cases for Care… more
- Commonwealth Care Alliance (Boston, MA)
- … staff, including nurse reviewers and support personnel. * Act as liaison with medical director , provider relations, case management and quality teams to support ... Management (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care… more
