- Fallon Health (Worcester, MA)
- …and clinical functions related to outpatient and inpatient, utilization management operations, including but not limited to prior authorization, concurrent ... + Recommends and implements innovative process improvements for the prior authorization and utilization management ...cost of care opportunities related to Utilization Management . + Works with VP/ Medical Director … more
- South Middlesex Opportunity Council (Framingham, MA)
- …casual Working Conditions: As part of the responsibilities of this position, the Utilization Management Coordinator will have direct or incidental contact with ... children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. Candidates must… more
- Humana (Boston, MA)
- …skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge planning ... Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care received by… more
- Evolent (Boston, MA)
- …Clinical Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall...selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with… more
- Evolent (Boston, MA)
- …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Humana (Boston, MA)
- …skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge planning ... , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned… more
- Evolent (Boston, MA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a… more
- Evolent (Boston, MA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a… more
- Humana (Boston, MA)
- …skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge planning ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- State of Massachusetts (Boston, MA)
- …Division of Insurance values inclusiveness and diversity within their employee and management teams. Within our community we strive to create and maintain working ... their skills and talents to serve our citizens. *_About the Role:_* The Director of Pharmacy Benefit Manager Oversight operating within the Health Care Access Bureau… more
- Cardinal Health (Tewksbury, MA)
- …DCOA as an objective tool to work with specific Medical Staff Departments or Utilization Management Teams to improve medication utilization + Ensures ... the Health System Director of Pharmacy (HSD), Director of Pharmacy Operations and Account Management ,...certification highly preferred + Previous experience with drug formulary management preferred + Prior experience as a… more
- Evolent (Boston, MA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. . ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management team. We can offer you a… more
- Humana (Boston, MA)
- …+ Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices **Work Schedule Monday - Friday w/standard ... hospitals/ Integrated Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management review… more
- Humana (Boston, MA)
- …with prior experience participating in teams focusing on quality management , utilization management , or similar activities **Preferred Qualifications:** ... community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare...Integrated Delivery Systems, health insurance, or clinical group practice management + Utilization management experience… more
- Evolent (Boston, MA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... Radiology you will be a key member of the utilization management team. We can offer you...I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools… more
- Commonwealth Care Alliance (Boston, MA)
- …and provider relationship management tools. * Understanding of claims operations, utilization management , and quality programs as they relate to provider ... in provider relations, contracting, or network operations, including 3-5 years in a director or senior management role. * Experience with value-based payment… more
- Bayer (Boston, MA)
- …diverse minds to make a real difference, there's only one choice.** **Associate Director , Regional Marketing - ONC Prostate - NYC/Boston** **Associate Director , ... communication strategy. 1) Key opinion leader (KOL) engagement and relationship management 2) Regional Convention leadership and execution 3) Speaker's bureau 4)… more
- Takeda Pharmaceuticals (Cambridge, MA)
- …a pharmaceutical commercial analytics or healthcare setting required. + 5+ years of prior management experience required. + High level of proficiency in ... of my knowledge. **Job Description** Join Takeda as a Director , Predictive Analytics and AI out of our Cambridge,...+ Advance Data Science and AI capabilities driving the utilization of predictive models in areas including Patient finding,… more
- Evolent (Boston, MA)
- …medical review roles that emphasize volume throughput, this position integrates utilization management with collaborative engagement and innovation. **Core ... for individuals facing cancer. As a Performance Suite Medical Director in Medical Oncology, you will play a pivotal...I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools… more
- Kyndryl (Boston, MA)
- …ultimately supporting execution. Partners will be focused on financial impact, utilization and contribution, client impact and leadership. **Contribute to Profitable ... development; Secure client references **Operational Excellence:** + Achieve individual and team utilization targets + Lead the design of complex engagements and take… more