- 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
- Brockton Hospital (Brockton, MA)
- … management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience ... PURPOSE OF POSITION: The Director of Case Management is responsible...enhances the quality of patient care while optimizing resource utilization . Provides training to staff on case management… 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 ... Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in the KY,… 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
- CenterWell (Boston, MA)
- …**Additional Information** Will report to the Director of Physician Strategy at Utilization Management . The Medical Director conducts Utilization ... a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health claims. The Medical … 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
- 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
- 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
- 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
- Evolent (Boston, MA)
- …public plans such as Medicaid is preferred. + Experience with value-based care, utilization management , or regulatory reporting (eg, HEDIS, NCQA, Milliman) is ... stakeholders. + Deep understanding of healthcare claims, reimbursement methodologies, and cost/ utilization KPIs, including prior authorisation data and key… 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