Top 433 Director of case management 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
Regional Director
VITRA Health —Boston, MA
- $145,000 - $155,000 a year
- Full-time
- 6 years
- Customer service
- Master's degree
- Disability insurance
- Health insurance
Quick Apply
Assistant Director, Clinical Services
The Home for Little Wanderers, Inc. —Walpole, MA
- LMFT
- 5 years
- Computer literacy
- 403(b) matching
- AD&D insurance
Clinical Supervisor- 3k sign on bonus!
Volunteers of America Massachusetts —Dorchester, MA
- $82,000 - $84,000 a year
- Full-time
- Clinic experience
- Research
- Residential
- 403(b) matching
- Health savings account
Quick Apply
3d
Clinical Director
Brook Behavioral Health —Abington, MA
- $115,000 - $145,000 a year
- Full-time
- Experience working with individuals with developmental disabilities
- HIPAA
- Experience working with children
- Health insurance
- Paid time off
Quick Apply
Continuous Care Hospice Nurse Per diem
All Care —North Andover, MA
- $48 - $50 an hour
- Weekends as needed
- RN License
- Mid-level
- Driver's License
- 403(b) matching
- Mileage reimbursement
Quick Apply
Masters level Clinician
Spectrum Health Systems —Dorchester, MA
- $66,500 - $68,000 a year
- Full-time
- Mid-level
- Master's degree
- Loan repayment program
- Health insurance
Quick Apply
Registered Nurse (RN) / Case Manager (Full or Part-Time)
Right at Home Boston Northwest —Bedford, MA
- $45 - $52 an hour
- Full-time
- RN License
- Mid-level
- Driver's License
- Travel reimbursement
- Dental insurance
Quick Apply
14d
Case Worker II / Life Coach
The Home for Little Wanderers, Inc. —Roxbury, MA
- Computer literacy
- Adults
- Children
- 403(b) matching
- AD&D insurance
Board Certified Behavior Analyst (BCBA)
Butterfly Effects —Everett, MA
- $90,000 - $110,000 a year
- Full-time
- Experience working with children
- Children
- Psychology
- Continuing education credits
- Health savings account
Quick Apply
11d
LPN - Licensed Practical Nurse: Per Diem or Part-Time - Skilled Nursing Rehab
Benchmark Senior Living —Lincoln, MA
- $40 - $44 an hour
- Part-time
- CPR Certification
- Nursing
- Skilled nursing facility
- Paid training
- Health insurance
Quick Apply
4d
Board Certified Behavior Analyst- Full Time
Specialized Autism Consultants —Everett, MA
- $80,000 - $100,000 a year
- Full-time
- Hybrid work
- Applied behavior analysis
- Management
- Mid-level
- Continuing education credits
- Mileage reimbursement
Quick Apply
Registered Nurse Case Manager, RN
South Shore Support Services —Hingham, MA
- $40 an hour
- Part-time
- Microsoft Word
- Background check
- Experience working with individuals with developmental disabilities
- Health insurance
- Dental insurance
Quick Apply
Clinical Director
NFI Massachusetts, Inc. —Wilmington, MA
- $85,000 a year
- Evenings as needed
- LMFT
- Writing skills
- Residential
Quick Apply
11d
Weekend Behavioral Health Nurse
Innovive Health —Winthrop, MA
- $74,000 a year
- Full-time
- Ability to walk for extended periods
- Mid-level
- Home Health
Quick Apply
Weekend Behavioral Health Nurse
Innovive Health —Hingham, MA
- $74,000 a year
- Full-time
- Ability to walk for extended periods
- Mid-level
- Home Health
- Continuing education credits
- Mileage reimbursement
Quick Apply
RN Hospice Case Manager
Hands and Hearts Hospice —Randolph, MA
- $90,000 - $110,000 a year
- Full-time
- Nursing
- Vital signs
- RN License
- Mileage reimbursement
- Health insurance
Quick Apply
11d
Registered Nurse (RN) Clinical Manager- Home Health
Interim HealthCare of Lexington, MA —Lexington, MA
- $85,000 - $120,000 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid holidays
- Health insurance
Quick Apply
7d
Mobile Crisis Master Clinician
High Point & Affiliated Organizations —Brockton, MA
- $70,200 - $80,000 a year
- Part-time
- LMFT
- Doctoral degree
- Current TB test
- Continuing education credits
- Disability insurance
Quick Apply
Licensed Clinical Supervisor
Confidential —Andover, MA
- $80,000 a year
- 8 hour shift
- Background check
- Psychiatry
- Mid-level
- Health savings account
- Health insurance
Quick Apply

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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

director of case management jobs in boston, ma

Medical Director

Regional Director

Assistant Director, Clinical Services

Clinical Supervisor- 3k sign on bonus!

Clinical Director

Continuous Care Hospice Nurse Per diem

Masters level Clinician

Registered Nurse (RN) / Case Manager (Full or Part-Time)

Case Worker II / Life Coach

Board Certified Behavior Analyst (BCBA)

LPN - Licensed Practical Nurse: Per Diem or Part-Time - Skilled Nursing Rehab

Board Certified Behavior Analyst- Full Time

Registered Nurse Case Manager, RN

Clinical Director

Weekend Behavioral Health Nurse

Weekend Behavioral Health Nurse

RN Hospice Case Manager

Registered Nurse (RN) Clinical Manager- Home Health

Mobile Crisis Master Clinician

Licensed Clinical Supervisor

I want to receive the latest job alert for director of case management in boston, ma

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