- CVS Health (Boston, MA)
- …- hospitals, outpatient networks, and value-based care relationships. The Medical Director will be responsible for overseeing the utilization review for health ... in-hospital utilization reviews and other quality activities. The Medical Director will be required to have a Massachusetts state...of the states in the New England Region *Previous UM experience with a Health Plan / Payor. *Previous… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Medical Director 's primary responsibility is the review of medical authorizations to determine the medical ... of a given service, level of care, or medical item/supply. The Medical Director 's work assignments involve moderately complex to complex issues where the analysis of… more
- US Tech Solutions (Canton, MA)
- …documentation necessary for coverage determinations and prepares cases for Medical Director Review, including the procurement of Plan Benefit Documents and Medical ... Necessity Guidelines, documents Medical Director coverage determinations. Notifies providers and/or members of the...a valid Massachusetts nursing license, preferably with UR or UM experience. This is a remote position but there… 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, ... overall efficiencies. + Manage individual projects for timely review with the Director , Clinical Pharmacy. + Participate in Medicare Stars performance measures to… more