- Harbor Health Services, Inc. (Mattapan, MA)
- …We are currently seeking a Director of Utilization Management & Quality Programs . Harbor Health offers an excellent, comprehensive benefits package including ... Programs of All-Inclusive Care for the Elderly, a program that allows frail elders to live in their...Operations, the Director of Utilization Management and Quality Programs is responsible for the day-to-day… more
- Fallon Health (Worcester, MA)
- …we strive to be the leading provider of government-sponsored health insurance programs -including Medicare, Medicaid, and PACE ( Program of All-Inclusive Care for ... Description and annually evaluate the effectiveness of the program . + Represents the UM Department in...related to Utilization Management. + Works with VP/ Medical Director to set agenda related to UM … more
- Point32Health (Canton, MA)
- … programs + Performs other roles/duties and projects as assigned by the Pharmacy UM Supervisor or Director **Qualifications** **- what you need to perform the ... leading not-for-profit health and well-being organization dedicated to delivering high- quality , affordable healthcare. Serving nearly 2 million members, Point32Health… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …with treating providers, as appropriate. At the request of the Senior Medical Director of the Physician Review Unit (PRU), the reviewer also provides clinical ... determination depends, making reasonable efforts to obtain relevant information via UM clinical reviewers, peer-to-peer outreach, and/or direct provider EMR access,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …transform healthcare? Bring your true colors to blue. The Role:The Compliance Program Consultant will focus on utilization management compliance and audit readiness ... and project milestones + Other responsibilities as identified by the Director Key Qualifications: + Strong attention to detail, Problem-solving and critical… more
