- 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
- CenterWell (Boston, MA)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...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
- Datavant (Boston, MA)
- …appropriate letter language to author appeal letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted ... + Work directly with the provider(s) and health plan Medical Director as needed to facilitate timely...table:** + Two (2) years managed care experience in UM /CM/CDI Department preferred + Knowledge of CMS, State Regulations,… more
- Humana (Boston, MA)
- …the Regional Vice President of Health Services (RVP) and Health Services Director (HSD). This position focuses on enabling connections with providers, supporting ... for provider partners regarding utilization management operations questions, interfacing with central UM team. + Collaborate with the delegation team to identify and… more
