- 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
- 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
- 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 (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 (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
- 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
- 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 (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
- Cognizant (Boston, MA)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years'… more
- Elevance Health (Woburn, MA)
- …responsibilities means that the medical director is directly involved in Utilization Management and Case Management . + Daily case reviews for both ... Director ** is responsible for serving as the Operational Medical Director for our care management...director provides clinical expertise in all aspects of utilization review and case management . Provides input… more
- Evolent (Boston, MA)
- …for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director in ... , you will be a key member of the utilization management team. We can offer you...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Brockton Hospital (Brockton, MA)
- PURPOSE OF POSITION: The Director of Case Management is responsible for planning, directing, and managing of the activities of the Case Management Program ... solves problems, referring exceptional issues to Vice President. The Director of Case Management is responsible for...directing, and managing of the activities of the Case Management Program for Signature Healthcare & Signature Medical… more
- Evolent (Boston, MA)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
- Evolent (Boston, MA)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... cases. you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
- Humana (Boston, MA)
- …health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management ... caring community and help us put health first** The Medical Director actively uses their medical...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Evolent (Boston, MA)
- …in a timely and accurate manner. . 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 , Oncology, you will be a...Oncology, you will be a key member of the utilization management team. We can offer you… more
- Evolent (Boston, MA)
- …in a timely and accurate manner. + 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...Surgery you will be a key member of the utilization management team. We can offer you… more
- East Boston Neighborhood Health Center (Revere, MA)
- …Oversees QI Program in collaboration with the PACE Senior Management Team (Executive Director , CPO, Medical Director , Clinical Director , Operations ... Clinical Quality director will collaborate with the medical director , clinical operations director ,...and work processes of the Quality Improvement (QI) and utilization management programs. Ensures regular progress in… more
- Elevance Health (Woburn, MA)
- **Behavioral Health Medical Director -Psychiatrist Appeals** **Location:** This role enables associates to work virtually full-time, with the exception of ... Friday. Half day Saturday rotation, once a month.** The **Behavioral Health Medical Director -Psychiatrist Appeals** is responsible for the administration of… more
- Elevance Health (Woburn, MA)
- ** Medical Director - Medical Policy** Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... required by law. Alternate locations may be considered. The ** Medical Director - Medical Policy** is...+ Supports coordination with external entities that develop clinical utilization management guidelines used by Company Plans… more