NewLicensed Mental Health Utilization Reviewer # 26-17647 US Tech Solutions, Inc.Licensed Mental Health Utilization Reviewer # 26-17647canton, MAThis role works collaboratively with Behavioral Health leadership, providers, and internal teams to ensure clinically appropriate, cost-effective, and compliant delivery of behavioral health services while supporting organizational goals. Job Summary: Under the supervision of the Utilization Management Supervisor, the Behavioral Health (BH) Utilization Management (UM) Clinician is responsible for conducting benefit coverage reviews and utilization management in accordance with regulatory guidelines and Enterprise contract requirements.
Clinical Reviewer - PASRR (2026-49948) University of MassachusettsClinical Reviewer - PASRR (2026-49948)Worcester, MARemoteAll Academic Accounting & Finance Administrative Professional Administrative Support Advancement Biotechnology Clinical Research Environmental Health & Safety Executive Faculty Healthcare Human Resources Information Technology Interns Library Maintenance and Facilities Management Nursing Office Assistant Other Post Doc Professional Technician I Public Safety Research Residents Retail & Dining Services Staff Assistant Staff Associate Volunteer. All Bedford Boston Brockton Brockton Canton Charlestown Danvers Devens Fall River Fitchburg Holyoke Jamaica Plain Jamaica Plan Lincoln Mattapan North Hampton North Quincy Pocasset Shrewsbury Springfield Taunton Tewksbury Waltham Westborough Westfield Woburn Worcester Wrentham.
Clinical Reviewer - PASRR University of Massachusetts Medical SchoolClinical Reviewer - PASRRWestborough, MassachusettsRemoteUnder the general supervision of the Associate Director, or designee, the Clinical Reviewer - PASRR is responsible for reviewing submitted referrals and any accompanying clinical documentation to the Pre-Admission Screening and Resident Review (PASRR) unit for completeness. Ability to understand and utilize resources for problem solving, in order to deal with problems involving multiple variables, effectively prioritizing and executing tasks in a high pressure, fast paced environment.
Clinical Reviewer PASRR UMass Chan Medical SchoolClinical Reviewer PASRRWestborough, MARemoteUnder the general supervision of the Associate Director, or designee, the Clinical Reviewer - PASRR is responsible for reviewing submitted referrals and any accompanying clinical documentation to the Pre-Admission Screening and Resident Review (PASRR) unit for completeness. Ability to understand and utilize resources for problem solving, in order to deal with problems involving multiple variables, effectively prioritizing and executing tasks in a high pressure, fast paced environment.
Clinical Nurse Reviewer Zelis Healthcare, Inc.Clinical Nurse ReviewerBoston, MA$59,000–$75,050 / yearThe Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.
NewPsychologist Reviewer Senior - ABA Elevance Health IncPsychologist Reviewer Senior - ABABoston, MA$107,280–$185,058 / yearD in clinical/counseling psychology and minimum of 5 years of experience in a Behavioral Health/Clinical setting and managed care experience which includes experience with the administration and interpretation of psychological test batteries; or any combination of education and experience, which would provide an equivalent background. Mentors Behavioral Health Care Management staff by assisting in training, attending utilization management rounds, and serving on interdepartmental initiatives; assists in developing a program around psychological and neuropsychological testing.
NewPsychologist Reviewer - ABA Elevance Health IncPsychologist Reviewer - ABABoston, MA$93,120–$160,632 / yearMentors Behavioral Health Care Management staff by assisting in training, attending utilization management rounds, and serving on interdepartmental initiatives; assists in developing a program around psychological and neuropsychological testing. D in clinical/counseling psychology and managed care experience which includes experience with the administration and interpretation of psychological test batteries; or any combination of education and experience, which would provide an equivalent background.
Cardiology Medical Reviewer (Project-Based) - Remote MMSCardiology Medical Reviewer (Project-Based) - RemoteBoston, MARemotePart timeWith a global footprint across four continents, MMS not only maintains an industry-leading customer satisfaction rating but also fosters a collaborative and inclusive work environment where employees can thrive. Responsible for strategies in pre and post marketing risk management, as well as keeping abreast of pharmacovigilance methods and trends in published literature and global regulations.
NewPhysical Therapy Utilization Management Reviewer Blue Cross and Blue Shield of Massachusetts IncPhysical Therapy Utilization Management ReviewerHingham, MA$42.18–$51.56 / hourThis position is part of a larger team and works independently and collaboratively to facilitate care using clinical skills, principles of managed care, nationally recognized medical necessity criteria, and company medical policies to conduct reviews that promote efficient and medically appropriate use of the member's benefit to provide the best quality care. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.
Contract Medical Literature Reviewer - Cardiology (DynaMed) EBSCOContract Medical Literature Reviewer - Cardiology (DynaMed)Ipswich, MassachusettsRemote$150–$200 / hourContractorEBSCO Information Services (EBSCO) delivers a fully optimized research experience, seamlessly integrated with a powerful discovery platform to support the information needs and maximize the research experience of our end-users. Working closely with the DynaMed Systematic Literature Surveillance (SLS) team, you will help determine whether evidence is appropriate for inclusion in DynaMed.
Third Party Reviewer Brigham and Women's HospitalThird Party ReviewerSomerville, MA$19.81–$28.30 / hourThe framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission.
Senior Billing Compliance Hospital Reviewer Dana-Farber Cancer Institute IncSenior Billing Compliance Hospital ReviewerBOSTON, MARemote$116,700–$132,000 / yearThe Senior Reviewer will be expected to pursue successful completion of multiple tasks collaborating effectively with many departments across the institute, Mass General Brigham Healthcare, Boston Children's Hospital and Beth Israel Deaconess Medical Center. Attend and actively participate in various meetings which may include CPT-Epic, New Services, Regional Campuses, Inpatient Billing, ADCC and AAMC as well as other continuous quality improvement processes and workgroups as needed.
Inpatient DRG Reviewer ZelisInpatient DRG ReviewerBoston, MassachusettsWhere the regrouped ‘new DRG’ differs from what was originally claimed by the provider, write a customer facing ‘rationale’ or ‘findings’ statement, highlighting the problems found and justifying the revised choices of new codes and DRG, based on the clinical evidence obtained during the review. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.
Director, Medical Reviewer LancesoftDirector, Medical ReviewerCambridge, MA$139.86Accountabilities Oversight of global medical review of individual case safety reports for Client investigational and marketed products from all sources includes but not limited to the following: seriousness criteria confirmation and expectedness/listedness assessment review of the reporter s causality and company causality assessment event confirmation and coding as per convention, analysis of similar events as required, provide sound rationale in Company. Proven ability to work in international environment and with cross-functional teams, with good interpersonal skills / assertiveness / team spirit / coaching skills.
Billing Compliance Reviewer Dana-Farber Cancer Institute IncBilling Compliance ReviewerBROOKLINE, MARemote$84,000–$91,300 / yearPartner with clinical providers, coding/HIM, revenue integrity, pharmacy, nursing, research billing, and practice operations to remediate findings, implement internal controls, and monitor corrective actions; track effectiveness of remediation through defined metrics. Reporting to the Director of Billing Compliance, the Billing Compliance Reviewer plans and executes risk-based audits, analyzes documentation and coding for medical necessity and regulatory adherence, and recommends corrective actions to mitigate compliance risk.
NewInpatient DRG Reviewer Zelis Healthcare, Inc.Inpatient DRG ReviewerMA$79,000–$99,750 / yearWhere the regrouped 'new DRG' differs from what was originally claimed by the provider, write a customer facing 'rationale' or 'findings' statement, highlighting the problems found and justifying the revised choices of new codes and DRG, based on the clinical evidence obtained during the review. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.
QC Data Reviewer - LNP and Lipids Eurofins Scientific SEQC Data Reviewer - LNP and LipidsBoston, MA$36–$40 / yearEurofins Scientific is an international life sciences company, providing a unique range of analytical testing services to clients across multiple industries, to make life and our environment safer, healthier, and more sustainable. From the food you eat, to the water you drink, to the medicines you rely on, Eurofins works with the biggest companies in the world to ensure the products they supply are safe, their ingredients are authentic, and labelling is accurate.
Clinical In-take Specialist Blue Cross and Blue Shield of Massachusetts IncClinical In-take SpecialistHingham, MAThe Clinical Intake Specialist (Customer Service) utilizes organizational and communication skills, principals of managed care, knowledge of regulatory requirements, and collaborative interactions with the clinical reviewers and provider community to facilitate efficient and timely requests. Assist implementation of all new utilization management processes and programs in accordance with business plans to provide quality customer service to all customers; Engage in cross-training to develop the variable skills necessary to support all team responsibilities.
RN Clinical Coordinator, Case Management, 32-Hours, Days, No Weekends or Holidays Athol HospitalRN Clinical Coordinator, Case Management, 32-Hours, Days, No Weekends or HolidaysAthol, Massachusetts$38–$57.48 / hourFull timeWorks collaboratively with a multidisciplinary team to determine each patient's needs concurrently including post-acute care when needed; addresses LOS issues, appropriate leveling of patient status; addresses potential needs, resources, referrals for other disciplines etc. Responsible for completing nursing sections of the SNF Level of Care forms for Mass Health patients in need of care, SNF placement, timely and efficiently and other forms assisting in transition of care as identified and collaborates with the social worker.
NewClinical Database Analyst Integrated Resources, IncClinical Database AnalystLexington, MassachusettsFull timeGenerate user requirements documentation and setup UATo Move visualizations to production through the development stages (dev/qa/prod) per existing process• Visualizations for Medical Reviewo Load the clinical trial datasets (in Study Data Tabulation Model) in Spotfire/iDARTso Map existing data visualization templates in iDARTs to the clinical trial datasetso Collect additional user requirements (from study physicians & data managers) and design new visualizations (Tables/Graphs)o Design new visualizations (Tables/Graphs) based on the user requirementso Conduct review sessions with the study team memberso Follow-up on needed improvements and changes neededo Move visualizations to production through the development stages (dev/qa/prod) per existing process 50%Decision-Making and Problem-Solving:Position requires an open mindset with good issue identification and problem-solving skills. Working Relationships/Interfaces:Primarily interacts with• ARBM team members (SAS Programmers and Central Monitors)• Clinical study team members (Clinical Scientist, Study Physician, Global Data Manager)• As needed, interacts with other staff within R&D (eg, biostats & programming)Education & Experience Requirements:• Minimum of a BS/BA degree or professional experience equivalent• At least 1 year relevant experience in pharmaceutical or health care industry• Advanced knowledge of TIBCO Spotfire required• Experience in working with clinical data (plus a general understanding of clinical trials) strongly preferredQualities and Characteristics:• Communication skills and active listening• Strong customer focus• Strong analytical mindset & Quality oriented• Innovative thinking• Flawless execution
Statistical Programming Lead, Clinical Data Management, R&D, Orion Corporation Orion CorpStatistical Programming Lead, Clinical Data Management, R&D, Orion CorporationBoston, MA$130,000–$230,000 / yearYou will join a growing oncology-focused Data Sciences function and provide strategic and operational leadership for statistical programming activities supporting oncology drug development programs across Phase I-III clinical development. Reporting to the Head of Clinical Development Data Services, this role is responsible for ensuring the timely delivery of high-quality, regulatory-compliant programming deliverables that support clinical development, regulatory submissions, and key business objectives.
Senior / Principal Statistical Programmer, Clinical Development Data Services, R&D, Orion Corporation Orion CorpSenior / Principal Statistical Programmer, Clinical Development Data Services, R&D, Orion CorporationBoston, MA$100,000–$180,000 / yearAs a Senior / Principal Statistical Programmer in a growing oncology-focused Data Sciences function, you are responsible for the development, validation, and delivery of clinical trial datasets, statistical outputs, and regulatory submission packages that support oncology drug development programs. Drive adoption of innovative programming approaches and AI-assisted workflows to improve efficiency, quality, and scalability of clinical trial deliverables.
RN Clinical Coordinator University of Massachusetts Medical SchoolRN Clinical CoordinatorWestborough, MassachusettsUnder the general direction of the Associate Director, or designee, the Clinical Coordinator is responsible to develop, prioritize, and oversee staff activities specifically designed to promote the coordination of care for those MassHealth members who have medically complex, chronic or catastrophic illnesses that require a customized approach to how, when, and where they receive medically necessary health care services. 3 years of related work experience with prior authorization and/or eligibility determinations for disabled, medically complex, home care, rehab or long term care populations strongly preferred.
Senior Director / Director, Non-Clinical Safety Project Specialist GSK plcSenior Director / Director, Non-Clinical Safety Project SpecialistWaltham, MA$224,400–$374,000 / yearAccountable for the quality of scientific thinking and outputs that characterise non-clinical safety, drug disposition and on-/off-target engagement for potential therapies, integrating data and knowledge into clear project narratives, optimized development plans, regulatory documents and decision-making. Through direct project delivery, cross-functional influence and support of the wider PTM community, enable the safe and efficient progression of medicines through clinical development, approval and, where required, post-market support.
Clinical Coordinator UMass Chan Medical SchoolClinical CoordinatorWestborough, MAUnder the general direction of the Associate Director, or designee, the Clinical Coordinator is responsible to develop, prioritize, and oversee staff activities specifically designed to promote the coordination of care for those MassHealth members who have medically complex, chronic or catastrophic illnesses that require a customized approach to how, when, and where they receive medically necessary health care services. 3 years of related work experience with prior authorization and/or eligibility determinations for disabled, medically complex, home care, rehab or long term care populations strongly preferred.
Clinical Coordinator (2026-49742) University of MassachusettsClinical Coordinator (2026-49742)Worcester, MAAll Academic Accounting & Finance Administrative Professional Administrative Support Advancement Biotechnology Clinical Research Environmental Health & Safety Executive Faculty Healthcare Human Resources Information Technology Interns Library Maintenance and Facilities Management Nursing Office Assistant Other Post Doc Professional Technician I Public Safety Research Residents Retail & Dining Services Staff Assistant Staff Associate Volunteer. Under the general direction of the Associate Director, or designee, the Clinical Coordinator is responsible to develop, prioritize, and oversee staff activities specifically designed to promote the coordination of care for those MassHealth members who have medically complex, chronic or catastrophic illnesses that require a customized approach to how, when, and where they receive medically necessary health care services.
Principal Clinical Content- Physician - UpToDate®, Physician Editor, Adult Neurology Wolters Kluwer N.V.Principal Clinical Content- Physician - UpToDate®, Physician Editor, Adult NeurologyMA$173,500–$310,000 / yearUpToDate editors work closely with outside authors, section editors, editors-in-chief, and peer reviewers to ensure the material is accurate and free of bias. In the remaining 10 to 20% time, Physician Editors should continue patient care activities, using their clinical experience to help ensure the content of the program is maximally useful at the point of care.
Clinical Pharmacist - Cardiothoracic Transplant MGH Brigham and Women's HospitalClinical Pharmacist - Cardiothoracic Transplant MGHBoston, MA$127,000–$160,000 / yearThis position requires application of advanced transplant training to lead immunosuppressive and opportunistic infection discussion on interdisciplinary rounds, transplant education for patients and healthcare professionals, transplant protocols and guidelines, quality improvement and research projects, and transplant training for the PGY-2 transplant resident and additional learners. Finally, Clinical Pharmacists provide medication and practice-related education/training and actively serve as preceptors for pharmacy residents and Doctor of Pharmacy students (MGH Pharmacy Residency website: https://www.massgeneral.org/education/pharmacy-residency .).
Clinical Pharmacist - Cardiothoracic Transplant MGH Mass General BrighamClinical Pharmacist - Cardiothoracic Transplant MGHBoston, MassachusettsThis position requires application of advanced transplant training to lead immunosuppressive and opportunistic infection discussion on interdisciplinary rounds, transplant education for patients and healthcare professionals, transplant protocols and guidelines, quality improvement and research projects, and transplant training for the PGY-2 transplant resident and additional learners. Finally, Clinical Pharmacists provide medication and practice-related education/training and actively serve as preceptors for pharmacy residents and Doctor of Pharmacy students (MGH Pharmacy Residency website: https://www.massgeneral.org/education/pharmacy-residency.) .
Executive Medical Director, Oncology Clinical Sciences TakedaExecutive Medical Director, Oncology Clinical SciencesBoston, MassachusettsThe actual base salary offered may depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job. OBJECTIVES: The Executive Director (ED) is responsible for ensuring ongoing review and agreement of the therapy area strategy and associated documents formulated by the Oncology Therapeutic Area Unit (OTAU) prior to their review and approval by appropriate governance committees.
NewSr. Data Scientist - AI Voice Lumeris Inc (Inactive)Sr. Data Scientist - AI VoiceMARemote$113,800–$154,525 / yearReporting directly to our VP of AI, you''ll split your time between two halves of the same problem: developing and fine-tuning the models that power clinical AI, and building the voice systems that let us test, stress, and trust those models before they ever reach a patient. Must-have hands-on experience building and deploying production voice or conversational AI systems - speech and speech-to-speech, working with real audio in live environments, not text-only NLP or chat.
NewSr. Data Scientist - AI Voice LumerisSr. Data Scientist - AI VoiceMassachusettsRemoteReporting directly to our VP of AI, you'll split your time between two halves of the same problem: developing and fine-tuning the models that power clinical AI, and building the voice systems that let us test, stress, and trust those models before they ever reach a patient. Must-have hands-on experience building and deploying production voice or conversational AI systems — speech and speech-to-speech, working with real audio in live environments, not text-only NLP or chat.
Senior Group Director Scientist AstraZeneca PlcSenior Group Director ScientistWaltham, MA$233,586.40–$350,379.60 / yearThe role also includes senior clinical science leadership across Hematology programs, working collaboratively with program- and study-level physicians or clinical leads to provide expert input on the medical and scientific aspects of compound development. Department leadership: Contributes to the Departmental Leadership Team by improving ways of working, identifying and resolving issues, setting departmental objectives, and supporting departmental resource planning and tracking.
Vice President, Legal - Lead Commercial Counsel Zenas BioPharma (USA) LLCVice President, Legal - Lead Commercial CounselWaltham, MA$272,000–$340,000 / yearProvide practical legal advice on pre-launch activities and launch strategy, including medical (e.g., MSL activities and programs), disease awareness, sales, marketing (brand messaging, activities and campaigns), marketing analytics, patient advocacy programs, advisory boards, incentive compensation for commercial personnel and other business activities. Zenas' earlier stage programs include ZB021, a clinical-stage, potentially best-in-class, oral, IL-17AA/AF inhibitor; ZB022, a preclinical, potentially best-in-class, oral, brain-penetrant, TYK2 inhibitor; and ZB014, a preclinical half-life extended anti-CD-19 and FcRIIb monoclonal antibody.
Telehealth Nurse (4-Day Work Week on site) VITRA HealthTelehealth Nurse (4-Day Work Week on site)Boston, MA$38–$48Through innovative home- and community-based services, Vitra supports aging adults, people with disabilities, and individuals with complex care needs— supported by a Nurse, and Case Manager, Vitra ensures clients receive compassionate, personalized, and dignified care. Requires lifting and carrying equipment and supplies weighing up to 35 pounds; requires pushing and pulling equipment and supplies weighing up to 35 pounds; requires walking and standing; requires frequent sitting more than 75% of the workday; requires the ability to navigate stairs; requires visual acuity and manual dexterity to operate equipment. .
RN Manager, Case Management / Utilization Management Blue Cross and Blue Shield of Massachusetts IncRN Manager, Case Management / Utilization ManagementHingham, MA$104,580–$127,820 / yearAn employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page.
NewUtilization Management Nurse, Escalation Support Brigham and Women's HospitalUtilization Management Nurse, Escalation SupportSomerville, MARemote$90,000–$107,000 / yearCollaborates with Nurse Reviewers, Medical Directors, providers, and interdisciplinary teams to address complex cases, facilitate timely determinations, and ensure accurate application of evidence-based criteria to appropriately answer and respond to provider, member, and interdisciplinary needs. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
Research Nurse Coordinator, Cell Therapy Brigham and Women's HospitalResearch Nurse Coordinator, Cell TherapyBoston, MA$41.72–$105.65 / hourMGBCI CTO Research Nurses are responsible for screening and enrolling patients for trials, patient education, triage phone support for patients in between treatment visits, symptom management, expert knowledge of protocols, meticulous documentation, and strong advocacy for patients while they are on trial. Accountable for interpreting the plan of medical care, assessment of patients'' clinical decision-making regarding nursing care, assuring nursing care is provided in a safe and competent manner, providing individualized nursing care, and evaluating nursing care for groups of patients.
RN Care Coordinator, Case Management, 8-Hours, Mornings, Weekends, 4 hour shifts on Saturdays and Sundays Heywood HospitalRN Care Coordinator, Case Management, 8-Hours, Mornings, Weekends, 4 hour shifts on Saturdays and SundaysGardner, Massachusetts$38–$78.93 / hourPart timeQuality & Statistical Data: Reviews medical record for abnormal findings,complications, delays and deviations from expected clinical outcomes reports such to Provider and/or Director to maintain an efficient, cost effective episode of care for each patient and documents intervention provided. Organizational Expectations Behavioral Attributes: The following behavioral attributes are required: achievement motivation, flexibility, concern for order, initiative, self-confidence, self control, customer service orientation, interpersonal effectiveness, teamwork and information seeking.
Nurse Excellence Programs Strategist Baystate HealthNurse Excellence Programs StrategistSpringfield, MA$118,934–$136,718 / yearThis system-wide Nurse Excellence Programs Strategist partners with nursing leadership, shared governance councils, and frontline nurses to cultivate a professional practice environment grounded in exemplary professional practice, transformational leadership, structural empowerment, new knowledge and innovations, quality, safety, well-being, and empirical nursing outcomes. Under the general direction of the System Director of Nursing Excellence, the Nurse Excellence Programs Strategist serves as a key strategic leader responsible for advancing systemwide professional nursing excellence through the successful achievement and sustainment of ANCC Magnet®, Pathway to Excellence®, and Practice Transition Accreditation Program (PTAP) designations.
Geriatric Social Worker Brigham and Women's HospitalGeriatric Social WorkerMA$67,537.60–$98,238.40 / yearThe social worker works with the older adult and caregiver to identify realistic goals while taking into account such factors as a) the appropriate type of intervention and/or level of care, b) the setting conducive to providing such intervention or care, c) the need for caregiver support to allow for the least restrictive level of care, d) transportation options/barriers and e) the steps to obtaining resources that make the achievement of goals possible. As an independent practitioner of social work, the GRACE Social Worker evaluates psychosocial needs and applies social work interventions with a high degree of autonomy, exercising independent judgment and initiative in carrying out social work functions and in applying social work values and ethics to complex situations.
Physician Advisor Sourcing Requisition UMass Chan Medical SchoolPhysician Advisor Sourcing RequisitionWestborough, MAUnder the general direction of the Medical Director, Director, or designee, the Physician Advisor is responsible for reviewing applicant medical records and making a clinical determination of eligibility for applicants seeking benefits and/or long term care services based on clinical guidelines. Physicians with experience/comfort in reviewing Pediatric cases are strongly preferred (ie Pediatricians, Family Medicine, or other provider with Pediatric experience/comfort).
Physician Advisor - Sourcing Requisition University of MassachusettsPhysician Advisor - Sourcing RequisitionWorcester, MAAll Academic Accounting & Finance Administrative Professional Administrative Support Advancement Biotechnology Environmental Health & Safety Executive Faculty Healthcare Human Resources Information Technology Interns Library Maintenance and Facilities Management Nursing Office Assistant Other Post Doc Professional Technician I Public Safety Research Residents Retail & Dining Services Staff Assistant Staff Associate Volunteer. All Bedford Boston Brockton Brockton Canton Charlestown Danvers Devens Fall River Fitchburg Holyoke Jamaica Plain Jamaica Plan Lincoln Mattapan North Hampton North Quincy Pocasset Shrewsbury Springfield Taunton Tewksbury Waltham Westborough Westfield Woburn Worcester Wrentham.
Physician Advisor - Sourcing Requisition University of Massachusetts Medical SchoolPhysician Advisor - Sourcing RequisitionWestborough, MassachusettsUnder the general direction of the Medical Director, Director, or designee, the Physician Advisor is responsible for reviewing applicant medical records and making a clinical determination of eligibility for applicants seeking benefits and/or long term care services based on clinical guidelines. Physicians with experience/comfort in reviewing Pediatric cases are strongly preferred (ie Pediatricians, Family Medicine, or other provider with Pediatric experience/comfort).
Medical Director Well Sense Health Plan IncMedical DirectorBoston, MA$173,000–$250,000 / yearJob Summary: The Medical Director will report to the Senior Medical Director of Utilization Management, Member Appeals & Grievances, and Medical Policy (Senior Medical Director of Utilization Management) and support the staff of the Office of Clinical Affairs in the areas of medical management daily medical necessity reviews, evaluation of medical policy, utilization trend management, quality, appeals and grievances, and pharmacy reviews. Collaborates with hospital physicians, medical directors, primary care physicians and nurse case managers in daily activities and initiatives to improve the health of the population, the quality and experience of care our members receive, and lower the overall cost of care at the population level.