23 medical director utilization management jobs found

The Project and Portfolio Management Office Director provides strategic and operational leadership for Dana-Farber’s project and portfolio management function within a complex healthcare, research, and administrative environment. This role establishes and advances enterprise standards for project intake, prioritization, governance, execution, reporting, and continuous improvement to support institutional strategy and effective use of resources. The Director leads a team of project management professionals, oversees portfolio performance, and partners with leaders across Information Services and other departments to ensure initiatives are aligned, appropriately resourced, and delivered with quality, transparency, and accountability. The role requires balancing long-range portfolio planning with day-to-day operational oversight, while strengthening project management capability across the Institute. Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a...

Reporting to the Vice President of Strategic Planning, Performance, and Digital Health, the Senior Director, Digital Adoption & Enablement provides strategic and operational leadership for enterprise efforts to drive successful adoption, sustained utilization, and value realization of digital tools, platforms, and workflows across Dana-Farber. This role establishes the vision, operating model, and priorities for digital adoption and enablement services supporting major institutional applications and platforms, including Epic, Microsoft 365 technologies, Workday, UKG, and other enterprise clinical, administrative, productivity, and collaboration systems. The Senior Director leads a multidisciplinary function that may include adoption and enablement managers, trainers, instructional designers, content developers, change management specialists, and organizational readiness professionals, and works closely with the Project & Portfolio Management Office, the Digital Consulting...

Working in a fast-paced, high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient advocate between Dana Farber Cancer Institute and various health plans. Reporting to the Prior Authorization Supervisor, the Clinical Authorization Specialist is responsible for managing all work related to molecular pathology, high-cost drug, and off-label drug authorizations. The Clinical Authorization Specialist is also responsible for managing denials related to front-end prior authorization, biosimilar drugs, pharmacy-benefit exclusion drugs, and claims. Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS, and related diseases. We strive to create an inclusive, diverse, and equitable environment where we...

The Proton Therapy Program Director provides strategic, operational, and administrative leadership for the Proton Therapy Program, ensuring the delivery of exceptional, patient-centered care while advancing the organization's clinical, academic, and research mission. This role is responsible for the planning, implementation, optimization, and ongoing management of proton therapy services, partnering closely with physician, nursing, operational, and research leaders to establish a world-class program. The Program Director oversees all aspects of program operations, including clinical workflow optimization, quality and safety, financial stewardship, workforce planning, regulatory compliance, and operational performance. This leader develops and executes strategic initiatives that support program growth, enhance the patient and provider experience, and integrate proton therapy services across the oncology continuum. Working collaboratively across multidisciplinary teams, the Program...

About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility leader, you will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal disease or chronic kidney disease. Training and advancement: You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning for our managers. The curriculum will cover onboarding, essential functions, leading your business, and advanced leadership. As a Clinical Manager, you may advance your career into an Area Team Lead or Director of Operations role. Our culture: We believe our employees are our most important asset - we value, care about, and support our people. We are there when you may need us most, from tuition reimbursement to support your education goals, granting scholarships...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Contributes to the Hospital’s mission by supporting proper classification and a safe plan of care. This professional licensed position will have an impact on finance and growth by classifying patients’ status appropriately and supporting the workflow and care plan to ensure the delivery of high quality, safe patient care while maintaining an expected length of stay within budget. This role is critical to the denial management, utilization review, and discharge planning process and will support the evolution towards a system approach in this realm. This role functions in a high integrity manner and as a case management and utilization expert, collaborating interdepartmentally to educate and improve processes to appropriate classify patient status, which ultimately improves reimbursement. The Utilization Management Specialist will impact the patient experience and...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. The Administrative Clinical Supervisor (ACS) is the on-site senior administrative/clinical person for the Medical Center during non-business hours. The ACS works in collaboration with staff, departmental leaders, and the Administrator on Call (AOC) to respond to administrative issues and ensure implementation of policies and procedures. This is a 36-hour night shift position, with 12-hour shifts from 7:00 PM to 7:30 AM, rotating every third weekend. Join a dynamic team where you'll gain leadership experience while supporting hospital-wide operations across all units. Job Description: Essential Responsibilities: Facilitates patient throughput by assessing and addressing local unit needs and the allocation of resources including staff and materials. Leads response to Code Help policy in collaboration with Admission Facilitator, Patient Access...

Lead Clinic Coordinator: In addition to the responsibilities of the Clinic Coordinator I and II, the Lead has additional duties outlined below: Leadership: • Role model and resource to the Clinic Coordinator team • Motivates and drives effective performance of the team • Possesses knowledge of multiple disease specific programs • Working in coordination with the Practice Manager and Project managers, serves as leader/champion in the roll-out of initiatives and projects • Establishes and develops strong working relationship with Nurse Director and Charge Nurses • Participates in interviewing prospective candidates • Contributes input on annual performance evaluation for Clinic Coordinators • Ability to learn rapidly, multi-task, and adapt quickly to an ever-changing environment. • Communicates team concerns, performance issues, and trends, to the Practice Manager • Maintains strong lines of communication with the Practice Manager • Understands and aligns with Practice Manager...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Where You’ll Work You will lead 2 North, a 31-bed adult medical-surgical and telemetry unit at Milton Hospital. The unit cares for a diverse patient population, including individuals with complex medical conditions and those recovering from surgery. As part of our close-knit community hospital, you’ll work alongside a collaborative team that is committed to exceptional patient care, teamwork, and professional growth. What You’ll Do As Nurse Manager, you will provide clinical, operational, and administrative leadership for 2 North, ensuring the delivery of safe, high-quality, patient-centered care. You will oversee daily operations, staffing, quality improvement initiatives, and regulatory compliance while fostering a positive and engaged team culture. Partnering with physicians, nursing leaders, and interdisciplinary colleagues, you’ll use data-driven...

Intention Healthcare, an Essen Health Care company, is a specialized medical group dedicated to providing accessible medical care to vulnerable and underserved patients who require care at home. Intention Healthcare delivers an integrated model that spans in-home primary care, longitudinal care management, remote monitoring, and real-time support for caregivers. Our clinical programs are designed to improve quality, reduce avoidable utilization, and expand access for members who face barriers to traditional care. Essen Health Care is the place Where Care Comes Together! Founded in 1999, our over 20-year commitment has fueled an unwavering dedication toward innovating a better healthcare delivery system. We are looking for the most talented and effective individuals to join our rapidly growing company. With over 1,100 employees and 400+ Practitioners, we care for over 250,000 patients annually. From medical providers to administration & operational staff, there is a...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Clinical Pharmacy Specialist – Ambulatory Cardiology. This role is Remote / Hybrid with on-site required in Burlington, MA. Job Description: Job Summary: The Clinical Pharmacy Specialist serves as a leader in clinical pharmacy practice in a specific clinical area, or various clinical areas, as determined by hospital needs. Specialists provide comprehensive clinical and distributive medication management services and will utilize their advanced clinical skills in the provision of evidenced-based, safe, and cost-effective drug therapy to achieve optimal medication therapy outcomes. They serve as a drug information and educational resource for the pharmacy staff, patients, residents/students, medical staff, nursing staff, and other healthcare professionals. The Clinical Pharmacy Specialist will participate in the development of clinical...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. The Executive Director must be an experienced healthcare leader with an in-depth understanding of clinical operations across the organization as well as in her/his assigned divisions. The Executive Director will work alongside the LHMC executive leadership team to improve clinical quality and promote the growth of his/her division. Reporting to a member of the Senior Leadership team, the Executive Director is responsible for the overall operational, clinical and financial performance of the Division of Imaging Services (all sites included if applicable). The Executive Director works in collaboration with Vice Presidents, physician leadership, business managers, and finance and nursing leadership to establish yearly performance goals for each division which are aligned with the vision and mission of Lahey Hospital and Medical Center. The Executive Director has...

Reporting to the Manager of Prior Authorization, the Prior Authorization Supervisor is responsible for managing the operational workflows and staff obtaining drug and laboratory procedure prior authorizations from third-party payers. This work will primarily address on-/off-label drugs and molecular pathology procedures provided in the outpatient hospital setting. A key focus of the Prior Authorization Supervisor will be to apply appropriate medical knowledge to all functions of the prior authorization work. He/She will oversee and ensure staff applies appropriate medical knowledge and training. The Prior Authorization Supervisor will assist with prior authorization medical necessity inquiries, with a primary focus on drug and laboratory prior authorizations. Prior Authorization work requires its staff to serve as liaisons between the clinical team and third-party payers. The Prior Authorization Supervisor will demonstrate a strong ability to collaborate with these key...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. 40 hours per week; 9:00am-5:30pm or 9:30am-6:00pm; Rotate Every Third Weekend & Holidays Job Description: Job Summary: The RN Case Manager (CM) facilitates the coordination of care for those patients admitted to medical, surgical services, ICU, and as needed for outpatient areas including but not limited to the Emergency Department, PACU and Preadmission testing. The case manager consults and collaborates in activities related to the establishment of appropriate levels of care. He/She reviews patient's medical records and participates in direct and indirect communication with care givers to ensure continued appropriate level of acre, including the level of care of elective surgical cases. The case manager provides ongoing education to the physicians and nurses about levels of care. The RN Case manager, performs, consults, and collaborates in...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Job Description: The Vice President of Addiction Services reports to the President of Behavioral Services and provides executive leadership for the strategic direction, operational performance, financial stewardship, regulatory compliance, and continued growth of the Addiction Services continuum across Beth Israel Lahey Health Behavioral Services (BILHBS). Working in a dyadic partnership with the Medical Director of Addiction Services, the Vice President  is responsible for  the oversight and advancement of a comprehensive, integrated system of addiction care. This includes inpatient withdrawal management, clinical stabilization services, residential treatment, recovery housing, Opioid Treatment Programs (OTPs), medication clinics, and all associated inpatient and outpatient addiction services. The Vice President collaborates closely with physician...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Job Description: This position is responsible for the day-to-day operation of the OR Scheduling staff. Manages and coordinates on-line scheduling of operative procedures, assuring cost-effective utilization of staff, space, equipment, optimal timing for patients. When appropriate oversee schedules for provider clinics and call schedules Essential Responsibilities: 1. Assumes accountability for the efficient, effective function of the scheduling staff. 2. Assures appropriate allocation of personnel to essential tasks. Organizes, overseas work schedule for optimal; utilization of staff. 3. Develops a quality measures for performance. Serves as a training resource to less experienced staff. 4. Assures data accuracy through collection, interpretation, and integration of data essential for efficient, effective scheduling in all OR sites. 5....

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Reporting to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in investigating patient safety incidents, risk management, reviewing publicly reported quality data by reviewing charts in the EMR, reviewing outliers, compiling reports and serving as the liaison with clinical stakeholder and clinical committees in sharing the outcomes of safety incidents and data. In addition to the goal of optimizing performance on the key performance indicators and quality measures, the RN specialist also aims to foster a culture of safety by specifically focusing on high reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, interpret data, and implement quality improvement initiatives to deliver excellence in clinical care....

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. The RN Case Manager working in the Triad Model of Care Transitions partners with the interdisciplinary care team to facilitate the progression of care for the hospitalized patient. Together with the medical provider, the RN Case Manager collaborates with all members of the care team, focusing on the delivery of efficient, high-quality care. This position ensures the appropriate utilization of clinical resources with a goal of a safe and timely discharge for the patient. This role navigates health system services to support effective transitions while advising the team on healthcare industry compliance. The RN Case Manager must be adept at driving throughput metrics, clinical effectiveness, and fiscal responsibility. Weekday availability required! Job Description: Essential Functions: The RN Case Manager collaborates with the health care team to...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Under the direction of the President and within established organizational and departmental policies and procedures, the Chief Medical Officer (CMO) is responsible for the development, implementation and monitoring of standards of clinical practice, and for the overall integration, coordination and quality of clinical care provided by the medical staff of BID Needham. The CMO is responsible for the overall medical and administrative affairs related to health care delivery and medical staff management of patient care while providing a visible, institutional commitment to quality at BID Needham. The position fosters and maintains the partnership between the Hospital and its medical staff, aligning the quality processes and outcomes, assuring appropriate utilization of resources, championing a culture of safety, and supporting care standards to elevate the level of...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. The Manager, under the direction of the Director of Surgical Services, is responsible for daily operational activities as well as the growth, development and mentoring of the Central Sterilization Department. The manager oversees the sterilization and distribution of medical instruments and equipment, ensuring a high standard of cleanliness and sterile conditions in the surgical services division. The manager is responsible for managing a team and implementing quality control measures. Job Description: DUTIES AND RESPONSIBILITIES: Develop and implement Central Sterilization department policies and procedures in order to support continuous improvement and quality assurance. Assist with Endoscopy policies as needed.  Ensure consistent and high-quality results for cleaning, decontamination, preparation and sterilization of surgical instrumentation and...