- Sinceri Senior Living (Boston, MA)
- …related office staff, hospital staff including social workers, discharge planners, utilization review , volunteer coordinators, rehabilitation director , ... trends and conversion ratios Assists with Maintaining a database of medical contacts/community resources along with knowledge of industry trends and… more
- Walker Sands (Boston, MA)
- …interview process, please let us know. Walker Sands is seeking a seasoned Account Director who can lead a portfolio of complex integrated and point solution programs ... creative, brand and strategy, marketing automation, PR and social media services. This Director will work with our channel experts to drive results for B2B… more
- OptiMindHealth (Needham, MA)
- …for both medical provider and patient populations (market share patterns; patient utilization data and medical provider referral trends) and both volume and ... growth in a specified territory and/or strategy by soliciting referrals from medical providers and healthcare institutions as directed by the OptiMindHealth senior… more
- Lifespan (Providence, RI)
- Summary: Reports to Director Specialty Pharmacy, or Ambulatory Manager as applicable. Under the supervision of the Pharmacist-In-Charge, Senior Clinical Pharmacist ... the patient's social determinants of health. Coaches professional staff (home medical team, other practitioners, and providers) on pharmaceutical care and… more
- Commonwealth Care Alliance (Boston, MA)
- … Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for providing leadership ... Serve as the lead for CCA's Utilization Review functions working closely with other medical ...preferred. + Primary care discipline, prior experience as Associate Medical Director (or equivalent) or physician reviewer… more
- Insight Global (Boston, MA)
- Job Description Insight Global is sourcing for a Utilization Management Director to join a not-for-profit community based healthcare organization within the ... within the Clinical Performance, Operations, and Innovation organization. The Director is responsible for providing strategic guidance to the...will start on day one of employment and include medical , dental, and vision insurance, as well as HSA,… more
- Commonwealth Care Alliance (Boston, MA)
- …The Manager, Utilization Management reports to the Director of Utilization Management * Oversees clinical decision review for services requiring prior ... staff, including nurse reviewers and support personnel. * Act as liaison with medical director , provider relations, case management and quality teams to support… more
- Evolent (Providence, RI)
- …new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as assigned mentor as ... Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a...Provides medical direction to the support services review process. Responsible for the quality of utilization… more
- Evolent (Providence, RI)
- …non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National...process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Humana (Providence, RI)
- …how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... management. + Utilization management experience in a medical management review organization, such as Medicare...on size of region or line of business. The Medical Director conducts Utilization Management… more
- Humana (Providence, RI)
- …role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with ... performing utilization management for inpatient authorizations training medical director team to assist and facilitate...**Key Responsibilities** **:** + Lead an operational team of Medical Directors to review authorizations and ensure… more
- Evolent (Providence, RI)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Providence, RI)
- …per inter-rater reliability process. + 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... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Humana (Providence, RI)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... management. + Utilization management experience in a medical management review organization, such as Medicare...on size of region or line of business. The Medical Director conducts Utilization Management… more
- Humana (Providence, RI)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... management. + Utilization management experience in a medical management review organization, such as Medicare...on size of region or line of business. The Medical Director conducts Utilization Management… more
- Brockton Hospital (Brockton, MA)
- …delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare ... management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience required.… more
- Evolent (Providence, RI)
- …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... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Providence, RI)
- …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... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Humana (Providence, RI)
- …put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate ... Medical Director works on problems of diverse scope and complexity...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with… more
- CVS Health (Boston, MA)
- …ensuring timely and consistent responses to members and providers. As a Medical Director you will focus primarily on review appeal cases for denied ... have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical… more
