Top 29 Utilization review physician Jobs in Boston Ma

Medical Director
WellSense Health Plan —Boston, MA
- $173,000 - $250,000 a year
- Full-time
- Background check
- Medicine
- Office
- Health insurance
- Dental insurance
Clinical Review Medical Director - Neurology - Remote
Optum —Boston, MA
- $248,500 - $373,000 a year
- Full-time
- Remote
- Medicine
- Microsoft Outlook
- 5 years
Quick Apply
Medical Director Cardiovascular Medicine
Cohere Health —Boston, MA
- $250,000 - $280,000 a year
- Remote
- Medicine
- 5 years
- BC/BE
- Paid parental leave
- Health savings account
Quick Apply
Medical Director Spine Surgery
Cohere Health —Boston, MA
- $260,000 - $280,000 a year
- Remote
- Medicine
- Surgery
- BC/BE
- Paid parental leave
- Health savings account
Quick Apply
Chief Medical Officer MelroseWakefield Health Care
MelroseWakefield Healthcare —Melrose, MA
- $385,000 - $425,000 a year
- Full-time
- Medicine
- PALS Certification
- BC/BE
Pediatrician | Community Health | Boston
Whittier Street Health Center —Boston, MA
- $200,000 - $225,000 a year
- Part-time
- Background check
- Medicine
- Management
- Health savings account
- Paid holidays
Quick Apply
Medical Director - Vascular Surgery - Remote
Optum —Boston, MA
- $248,500 - $373,000 a year
- Full-time
- Remote
- Medicine
- Microsoft Outlook
- Surgery
Quick Apply
Medical Director Orthopedic Surgery
Cohere Health —Boston, MA
- $240,000 - $260,000 a year
- Remote
- Medicine
- Surgery
- 5 years
- Paid parental leave
- Health savings account
Quick Apply
Strategic Medical Director, PM&R / Post-Acute Care & DME
Cohere Health —Boston, MA
- $285,000 - $305,000 a year
- Remote
- Medicine
- 5 years
- BC/BE
- Paid parental leave
- Health savings account
Quick Apply
Urgent Care Physician
Harvard University —Cambridge, MA
- Part-time
- Background check
- Medicine
- BLS Certification
- Commuter assistance
- Health insurance
Chief Medical Officer for Tufts Medicine Behavioral Health Hospital
Tufts Physician Organization —Boston, MA
- $320,000 - $375,000 a year
- Email
- CPR Certification
- Medicine
- Psychiatry
5d
Virtual Primary Care Physician
Firefly Health —Boston, MA
- $300,000 - $325,000 a year
- Full-time
- Medicine
- 5 years
- Primary Care
- 401(k)
Quick Apply
Clinical Director, Adult Medicine
The Dimock Center —Roxbury, MA
- $260,000 - $280,000 a year
- Weekends as needed
- Adults
- 3 years
- Ob/Gyn
Quick Apply
Chief Medical Officer, BID-Needham Hospital
Beth Israel Lahey Health —Needham, MA
- $300,000 - $360,000 a year
- Full-time
- Doctoral degree
- Hospital
- Customer service
Chief Medical Officer, Primary Care, BILH Medical Group
Beth Israel Lahey Health —Cambridge, MA
- $300,000 - $337,500 a year
- Full-time
- Medicine
- Primary Care
- Mentoring
9d
Medical Director for Intention (Essen Healthcare)
Essen Health Care/ Intention —Boston, MA
- $250,000 - $350,000 a year
- Full-time
- Medicine
- Internal Medicine
- Primary Care
- Health insurance
- Dental insurance
Quick Apply
Team Medical Director- Urgent Care
Lynn Community Health Center —Lynn, MA
- $108,000 - $250,000 a year
- Full-time
- Spanish
- Management
- Certified Nurse Practitioner
- Health insurance
- Dental insurance
Quick Apply
Senior Medical Director,Medical Management
University of Massachusetts Medical School —Boston, MA
- $220,000 - $260,000 a year
- Full-time
- Hybrid work
- Medicine
- 5 years
- Office
Medical Director – Intention, Massachusetts region
Essen Health Care —Boston, MA
- $250,000 - $350,000 a year
- Full-time
- Medicine
- Psychiatry
- Internal Medicine
- Health savings account
- Health insurance
Quick Apply
12d
Medical Director Essen Health/Intention Boston Area
Essen Health Care —Boston, MA
- $275,000 - $350,000 a year
- Full-time
- Medicine
- Psychiatry
- Internal Medicine
- Health insurance
- Dental insurance
Quick Apply
12d

I want to receive the latest job alert for utilization review physician in boston ma

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

utilization review physician jobs near boston ma

Director Of Product Management jobs in Boston, MA

Chief Medical Officer jobs in Cambridge, MA

Chief Medical Officer jobs in Boston, MA

Medical Director jobs in Boston, MA

Urgent Care Physician jobs in Cambridge, MA

Pediatrician jobs in Boston, MA

Clinical Director jobs in Boston, MA

Senior Medical Director jobs in Boston, MA

Director Of Product Management jobs in Herndon, VA

Behavioral Health Case Management Ii jobs in Oklahoma City, OK

Waste Management jobs in Columbus, OH

Band Director jobs in Dallas Fort Worth, TX

Director Of Product Management jobs in San Marcos, TX

Director Of Product Management jobs in Chicago, IL

Director Of Product Management jobs in St. Louis, MO

Chief Medical Officer jobs in Remote

Chief Of Staff jobs in Texas

Police Officer jobs in Maine

Chief Of Staff jobs in Austin, TX

Chief Medical Officer jobs in Williamsburg, VA

Medical Director

WellSense Health Plan -
Boston, MA

Apply Now

Job Details

Full-time
$173,000 - $250,000 a year

Benefits

Health insurance
Dental insurance
Flexible spending account
Paid time off
Vision insurance
403(b)
Opportunities for advancement

Qualifications

Managed care organization experience
Medical License

Full Job Description

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job 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.

Our Investment in You:

Full-time remote work

Competitive salaries

Excellent benefits

Key Functions/Responsibilities:

Provides clinical case review, consultation and oversight for all utilization management activities in a fashion that is compliant with all federal, state, and NCQA requirements

Conducts review of prior authorizations, concurrent reviews and retrospective medical necessity reviews that do not meet standard criteria and determines coverage

Works with the Senior Medical Director of Utilization Management to identify appropriate use of InterQual criteria and Medical Policy

Works with the Senior Medical Director to ensure consistent medical decision making for all physician reviewers, including the contracted physicians

Conducts clinical review of appeals and grievances in a fashion that is compliant with all federal, state and NCQA requirements

Develops and supports clinical initiatives to support department quality improvement and utilization management goals

Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment

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

Participates in and chairs clinical committees as assigned by the Senior Medical Director of Utilization Management

Supports quality, and pharmacy committees and activities

Provides input to the strategic planning process for the Office of Clinical Affairs as requested

Represents the Chief Medical Officer or Senior Medical Directors in Massachusetts, New Hampshire and other locations as requested

Supervision Exercised:

Indirect technical direction is provided to the organization

Supervision Received:

General direction is received weekly

Qualifications:

Education:

Graduate as a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) from an accredited allopathic or osteopathic medical school

Experience:

8-10+ years of related experience is required including a minimum of 5 years direct clinical experience and a minimum of 3 years experience in medical management in a managed care setting

Preferred/Desirable:

Preference for those with Board Certification in the following:

Internal Medicine

Internal Medicine-Pediatrics (Med Peds)

Family Medicine

Emergency Medicine

Certification or Conditions of Employment:

Pre-employment background check

Active or lifetime board certification in recognized medical specialty of the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)

Current unrestricted licensure as an MD or DO in Massachusetts and New Hampshire is required, or ability to obtain in a reasonable timeframe

Current unrestricted licensure as an MD in Massachusetts or New Hampshire is preferred

No restriction on participation in Medicare or Medicaid programs

Competencies, Skills, and Attributes:

Excellent demonstrated clinical skills and knowledge

Excellent written and verbal communication skills.

Comprehensive knowledge of accrediting organizations such as NCQA.

Comprehensive knowledge of InterQual protocols, HEDIS, and other quality measures.

Knowledge of Medicare and state Medicaid regulations, guidelines, and standards.

Proven leadership skills and relationship building.

Knowledge of managed care principles and processes.

Ability to work independently with intermittent supervision.

Adhere to appropriate turn-around-times and deadlines while maintain results of high quality and reliability.

Working Conditions and Physical Effort:

Work is normally performed in a typical remote interior/office work environment

No or very limited physical effort required. No or very limited exposure to physical risk

Ability to travel to locations within New Hampshire and Massachusetts

Regular and reliable attendance is an essential function of the position

Compensation Range

$173,000 - $250,000

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note: This range is based on Boston-area data, and is subject to modification based on geographic location.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

Apply Now

Refine Your Search

utilization review physician jobs in boston ma

Medical Director

Clinical Review Medical Director - Neurology - Remote

Medical Director Cardiovascular Medicine

Medical Director Spine Surgery

Chief Medical Officer MelroseWakefield Health Care

Pediatrician | Community Health | Boston

Medical Director - Vascular Surgery - Remote

Medical Director Orthopedic Surgery

Strategic Medical Director, PM&R / Post-Acute Care & DME

Urgent Care Physician

Chief Medical Officer for Tufts Medicine Behavioral Health Hospital

Virtual Primary Care Physician

Clinical Director, Adult Medicine

Chief Medical Officer, BID-Needham Hospital

Chief Medical Officer, Primary Care, BILH Medical Group

Medical Director for Intention (Essen Healthcare)

Team Medical Director- Urgent Care

Senior Medical Director,Medical Management

Medical Director – Intention, Massachusetts region

Medical Director Essen Health/Intention Boston Area

I want to receive the latest job alert for utilization review physician in boston ma

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected