- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …senior leaders for decision making + Apply their clinical knowledge when assessing/auditing medical records and UM letters against medical necessity criteria ... and scope projects; keep project leads, senior consultants, and Director informed of key issues/ risks and meet deadlines...of key issues/ risks and meet deadlines by tightly managing deliverables, coordinating input from leaders, and ensuring all… more
- Highmark Health (Boston, MA)
- …in the capacity as a clinical pharmacist the incumbent may also review UM requests; provide consultation into the case and disease management identification process, ... and consult with the Organization's Associate Medical Directors and Medical Directors when appropriate,...and Targeted Medication Reviews. + Identify and assist in managing department process improvements to maximize overall efficiencies. +… more