- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Director of Utilization Management leads and manages all utilization management (UM) functions for physical ... state and federal regulatory requirements and all applicable accreditation standards. The Director of Utilization Management is responsible for setting… more
- CVS Health (Boston, MA)
- …Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and… more
- Humana (Boston, MA)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Boston, MA)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... with prior experience participating in teams focusing on quality management , utilization management , case ...management operational improvements, including those within the medical director area + Participate in call rotation + Develop… more
- Humana (Boston, MA)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... skills, with prior experience participating in teams focusing on quality management , utilization management , and acute inpatient rehabilitation… more
- Evolent Health (Boston, MA)
- …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as ... the culture. **What You'll Be Doing:** As a Medical Director for the Musculoskeletal department, you will be a...department, you will be a key member of the utilization management team. We can offer you… more
- CVS Health (Boston, MA)
- …care more personal, convenient and affordable. **Position Summary** The Lead Director of Observability Governance is responsible for leading strategic planning for ... to meet the needs of all CVS Health businesses. As a Lead Director of Observability Governance, you will collaborate with observability engineering and operations… more
- Marriott (Boston, MA)
- …United States **Schedule** Full-Time **Located Remotely?** Y **Relocation?** N **Position Type** Management **JOB SUMMARY** The Director of Privileged Access ... as a service (IDaaS) platform + Graduate/post graduate degree **CORE WORK ACTIVITIES** + Director role focused on Privileged Access Management + This function is… more
- Humana (Boston, MA)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management + Utilization management experience in a… more
- AmeriHealth Caritas (Manchester, NH)
- …BH treatment requests. The Med. Dir. SUD/BH will make recommendations regarding ACNH utilization management programs based on member and provider needs and ... that AmeriHealth Caritas New Hampshire's substance use disorder and behavioral health care management , utilization management and quality management … more
- CVS Health (Boston, MA)
- …of our members' health care and social determinant needs. The Duals Care Management (CM) Medical Director will participate in designing, developing and deploying ... members' physical, behavioral and socioeconomic needs. * Partner closely with the Executive Director of Duals and other Duals Care Management leadership to… more
- Takeda Pharmaceuticals (Boston, MA)
- …to bring life-changing therapies to patients worldwide. Join Takeda as an Associate Director , Portfolio Management Lead where you will ensure that the PharmSci ... and strategic support on high-priority, complex, cross-functional program and portfolio management initiatives. As part of the PS Program Leadership, you will… more
- Evolent Health (Boston, MA)
- …As a Behavioral Health Field Medical Director will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Evolent Health is looking for a Behavioral Health Medical Director to be a member of the Evolent clinical...Reviewers. **What you'll be doing:** + Supports pre-admission review, utilization management , and concurrent and retrospective review… more
- Grant Thornton LLP (Boston, MA)
- As a Transaction Management Director , you'll focus on buy-side and sell-side transaction management engagements, serving dynamic organizations with ... teams + Provide expertise in the following: + Deal Management Office support + Standalone, one-time, and stranded cost...professional development + Meeting or exceeding targeted billing hours ( utilization ) + Other duties as assigned You have the… more
- The Hartford (Boston, MA)
- Managing Director - UQ06CB We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here ... the future. Reporting to the AVP of Alternative Distribution, the Managing Director will provide direct underwriting leadership, sales leadership, and agency … more
- CVS Health (Boston, MA)
- …advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management , quality management , network management ... will be responsible for provider education regarding best clinical practices, utilization management , care management , claims adjudication, pharmacy … more
- Beth Israel Lahey Health (Burlington, MA)
- …healthcare services. Leverage health informatics and data analytics across campuses The Director will oversee the integration and utilization of health ... taking a job, you're making a difference in people's lives.** The Institute Director will develop the strategic plan, research priorities, and recruit and build a… more
- Daiichi Sankyo Inc. (Boston, MA)
- …national payer landscapes with expertise in formulary decisions, reimbursement policy, utilization management criteria, prior authorization processes and appeal ... areas centered around rare diseases and immune disorders. **Summary:** The Associate Director Field Reimbursement (ADFR) is a critical front-line member of the DSI… more
- South Middlesex Opportunity Council (Framingham, MA)
- …develop and evaluate staff by providing timely mentoring, training and performance management . + In collaboration with the Medical Director , responsible for ... SUMMARY The Clinic Director is responsible for ensuring the overall quality...Participate in quality improvement planning and action with entire management team. + Monitor caseloads and work with the… more
- Harvard University (Cambridge, MA)
- …Office Location:USA - MA - Boston Business Title:Associate Director of Statistical ProgrammingSub-Unit: Appointment End Date:30-Nov-2027Salary Grade ... Computer Science, or related field + Experience working with all levels of management and consulting with key business stakeholders + An ability to influence for… more