- Humana (Boston, MA)
- …Degree or BSN degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + ... help us put health first** We are seeking a Senior Accreditation Professional who will work in...on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming … more
- Evolent (Boston, MA)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... , you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work… more
- Elevance Health (Boston, MA)
- …Senior Leadership Teams in the areas of medical provider relations, quality management , utilization management , clinical systems design, and clinical ... the state employed. **Preferred Skills, Capabilities and Experiences** + **Leadership & Utilization Management :** Prior leadership role in a managed care… more
- Evolent (Boston, MA)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to… more
- Evolent (Boston, MA)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... Director you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Boston, MA)
- …Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Point32Health (Canton, MA)
- …service to our members, partners, colleagues and communities. **Job Summary** The Senior Clinical Pharmacist is responsible for the development and maintenance of ... pharmacy programs, and clinical programs/initiatives to meet regulatory and accreditation requirements and to meet Point32Health's corporate priorities. The … more
- Athena Health Care Systems (Lakeville, MA)
- …available to personnel. + Ensuring coordination with other departments, services, and senior management , as appropriate. + Ensuring staff and organization stay ... + Two (2) to five (5) years experience in health care management required, preferably hospice. + Understanding of hospice care, Medicare Hospice Certification,… more
- Evolent (Boston, MA)
- …members and providers + Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director. + Appropriately ... policies + Creates adverse determination notifications that meet all accreditation , State, and Federal criteria + Uses Plain Language...identifies potential cases for Care Management programs + Communicates appropriate information to other staff… more
- Boston University (Boston, MA)
- …Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, ... weeks of nursery per year + Demonstrated leadership and management skills + Demonstrated strength in collaboration and interdisciplinary...and accreditation requirements + Identifies clinical quality improvement opportunities to… more
- Colliers Engineering & Design (Hingham, MA)
- …a client's satisfaction and firm's expectations in terms of resource utilization and profitability. Actively manages client budgets, schedules, programs, project ... in the collection process as this pertains to architectural projects and management of client relationships. + Produces project(s) Schedules, Work Plans, and… more