- Fallon Health (Worcester, MA)
- …Medical Officer will provide strategic leadership and oversight responsibility for the clinical and operational utilization management activities for all ... outpatient care, and staff across all product lines. **Responsibilities** ** Utilization Management :** + Oversees all administrative, operational and … more
- Beth Israel Lahey Health (Westwood, MA)
- …systems to enter and access patient care information. 7. Participates in quality management and utilization review programs. 8. May coordinate the work of ... you're making a difference in people's lives.** Job Summary: The Pharmacy Direct Staff Pharmacist is responsible for the quality assurance of the provided pharmacy… more
- Edwards Lifesciences (Providence, RI)
- …post-case management , 3 Mensio management , Therapy Awareness program management and clinical education programs. + Implementing sales and educational ... and implementing growth strategies within focused accounts in partnership with Sales Management . + Developing clinical champions among current and potential… more
- Veterans Inc. (Worcester, MA)
- …of the men's Residential Rehabilitation Services (RRS) program is responsible for providing clinical supervision to the RRS program staff . This position is ... DAY TO DAY: + Works in collaboration with the Program Manager and provides clinical supervision and leadership of designated staff . + Responsible for oversight… more
- Point32Health (Canton, MA)
- …. **Job Summary** Under the direction of the Pharmacy Utilization Management (UM) Supervisor, the Per Diem Clinical Pharmacist is responsible for ... of or experience with Medicare Part B & D, Medicaid, and Drug Utilization Management . Prior authorization experience, including reviewing drug use criteria for… more
- Humana (Providence, RI)
- …corporate communications to be shared with senior leadership. + Supports trend management by conducting analysis of drug spend, utilization , and/or approval ... communicating with staff in different positions and all levels of management positions + Manages the Humana Michigan FIDE-SNP health plan relationship with our… more
- Evolent (Providence, RI)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse… more
- Beth Israel Lahey Health (Westwood, MA)
- …in people's lives.** The Medication Renewal Center Pharmacist provides comprehensive clinical pharmacy support in collaboration with the clinics of BILH in ... goal to improve operational efficiencies and deliver enhanced refill and medication management services. The pharmacist will practice under a scope of agreement to… more
- Edward M. Kennedy Community Health Center, Inc. (Milford, MA)
- …team is expanding across sites to support this growth. We are currently hiring a Clinical Care Manager based in Milford, MA. The Clinical Care Manager (CCM) ... provides, coordinates, and organizes evidence-based care management to chronic disease patients, especially to those who...and embrace the richness of the cultures of our staff and community. You are a good fit for… more
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …team is expanding across sites to support this growth. We are currently hiring a Clinical Care Manager - OBAT RN based in Framingham. As part of a team-based ... approach to care, the Clinical Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to Medical Assistant Treatment Program… more
- Evolent (Providence, RI)
- … 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 ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Point32Health (Canton, MA)
- …Develop comprehensive strategy to position Point32Health as a leader in utilization management and effectiveness, including pre-service, concurrent post-service ... (https://www.point32health.org/) . **Job Summary** The Vice President of Medical Management , reporting to the Senior Vice President, Health Care Services… more
- Highmark Health (Providence, RI)
- …per week (Tuesday-Thursday).** This role supports the full application product lifecycle for ** clinical and utilization management software** , with a ... and technical teams. They function as a pivotal bridge, translating high-level ** clinical and utilization management software** business needs into… more
- Evolent (Providence, RI)
- …Cardiologist)** Are you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical ... appropriate, high-value care aligned with clinical guidelines. + Collaborate with leadership, management , and clinical staff to address complex cases and… more
- Parexel (Providence, RI)
- …Data Management Lead to join our team. If you have a passion for clinical research, strong project management skills, and a knack for data management , ... Science, OR equivalent industry experience. + 7+ years experience in pharmaceutical/biotech clinical data management / Biometrics ( clinical trial data… more
- Evolent (Providence, RI)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Evolent (Providence, RI)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Evolent (Providence, RI)
- …Doing:** As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** . Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Evolent (Providence, RI)
- …Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Fallon Health (Worcester, MA)
- …Nurse in a clinical setting required. * 2 years' experience as a Utilization Management /Prior Authorization nurse in a managed care payer preferred. * One ... the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge,… more