- Commonwealth Care Alliance (Boston, MA)
- …promote the development of a high quality team.collaboration with the broader clinical organization. - Ensures that utilization management processes are ... with responsibility for managing the effective utilization of healthcare services, case / disease management , program development/ management /evaluation and… more
- Commonwealth Care Alliance (Boston, MA)
- …and support personnel. - Act as liaison with medical director, provider relations, case management and quality teams to support care coordination and integrated ... Management reports to the Director of Utilization Management - Oversees clinical decision review for...compliance with CMS, NCQA and state Medicaid requirements. - Lead preparation for internal and external audits (eg CMS… more
- Parexel (Boston, MA)
- …and propose /execute remediation plan in coordination with line manager and Project Leader in case of client dissatisfaction Business Development Support - ... your Rheumatology experience and Lupus expertise to an Industry Leader , Parexel!** In anticipation of future needs, we are...task contracted) and according to the assigned role (Global Lead Physician GLP or Regional Lead Physician… more
- Beth Israel Lahey Health (Boston, MA)
- …you're not just taking a job, you're making a difference in people's lives.** Provide clinical case management and support to high-risk patients in a large ... continuity of care. 2. Provides consultation to the team around patient management , risk management and ethical issues.. Documents assessments and care… more
- HCA Healthcare (Derry, NH)
- …Nurse license or compact state Registered Nurse license + Two or more years of clinical experience. + Case Management , Utilization & Managed Care experience ... care with a focus on evaluating the appropriateness of clinical care, medical necessity, admission status, level of care,...care, and resource management . + The RN Case Manager Team Lead will coordinate activities… more
- Elevance Health (Woburn, MA)
- … clinical expertise in all aspects of utilization review and case management . Provides input on the clinical relevance to account reporting regarding use ... used for operational reviews. + Leading multidisciplinary rounds for case management /complex clinical ...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- CVS Health (Boston, MA)
- …members and providers. Leads all aspects of utilization review/quality assurance, directing case management Provides clinical expertise and business ... direction in support of medical management programs through participation in clinical team activities. Acts as lead business and clinical liaison to… more
- Cambridge Health Alliance (Everett, MA)
- Clinical Social Worker II (LICSW) - Inpatient Case Management Everett **Requisition Number:** 10253 **Location:** CHA Everett Hospital **Work Days:** Mon - ... Friday and Rotating Weekends/Holiday **Category:** Social Work **Department:** Inpatient Case Management Everett **Job Type:** Full time **Work Shift:** Day… more
- Genesis Healthcare (Beverly, MA)
- …of the rehabilitation department, including oversight related to case management , quality improvement, care planning, clinical utilization, and patient ... Overview Program Lead : Coverage area includes Beverly, Danvers, Peabody, Salem,...rehab department, including oversight related to case management , quality improvement, care planning, clinical utilization,… more
- Sanofi Group (Cambridge, MA)
- **Job Title** : Clinical Digital acceleration and innovation Lead **Location:** Cambridge, MA or Morristown, NJ **About the Job** Are you ready to shape the ... professional to join us as Digital acceleration & Innovation Lead . The Clinical Digital Acceleration & Innovation...role requires deep expertise in digital and AI within clinical development, strong program management skills, and… more
- Lawrence General Hospital (Methuen, MA)
- …staff. Responsibilities: + Collaborates with healthcare team, including but not limited to Case Management to ensure optimal disposition plans for all patients. ... + Provides clinical consultation to nursing staff or directs them to other resources. + Monitors and adjusts staffing based upon patient census and acuity. + Manages… more
- Elevance Health (Woburn, MA)
- …The **Behavioral Health - Case Manager II** is responsible for performing case management telephonically and/or by home visits within the scope of licensure ... substance abuse disorder needs. Subject matter expert in targeted clinical areas of expertise such as Eating Disorders (ED)...of the United States required. + Previous experience in case management and telephonic and/or in person… more
- Elevance Health (Woburn, MA)
- …The **Behavioral Health - Case Manager II** is responsible for performing case management telephonically and/or by home visits within the scope of licensure ... substance abuse disorder needs. Subject matter expert in targeted clinical areas of expertise such as Eating Disorders (ED)...of the United States required. + Previous experience in case management and telephonic and/or in person… more
- Devereux Advanced Behavioral Health (Woburn, MA)
- …care, respite, Foster Care, Licensing, bilingual, child welfare, social services, specialist, case manager, case management , compliance, human services, ... Devereux (TFC in Woburn, MA) has an immediate opening for a Bi-Lingual Case Coordinator._** **$1,000 Sign on Bonus** Base pay starting at $20.46/hour with additional… more
- Elevance Health (Woburn, MA)
- …2 years' experience in acute care setting preferred. + Minimum 2 years' "telephonic" Case Management experience with a Managed Care Company preferred. + Managed ... of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management...health related field and minimum of 5 years of clinical experience; or any combination of education and experience,… more
- Elevance Health (Woburn, MA)
- …care hospital setting, ie ER, ICU, Critical Care preferred. + Prior "telephonic" Case Management experience with a Managed Care Company preferred + Certification ... Case Manager II** is responsible for performing care management within the scope of licensure for members with...a BA/BS in a health-related field; 5 years of clinical experience; or any combination of education and experience,… more
- Elevance Health (Woburn, MA)
- …2 years' experience in acute care setting preferred. + Minimum 2 years' "telephonic" Case Management experience with a Managed Care Company preferred. + Managed ... different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager Senior** is responsible for care management within the… more
- Elevance Health (Woburn, MA)
- …8:00PM) The **Nurse Case Manager I** is responsible for performing care management within the scope of licensure for members with complex and chronic care needs ... **Nurse Case Manager I** **Location:** _Hybrid1:_ This role requires...assessments to identify individual needs and a specific care management plan to address objectives and goals as identified… more
- Elara Caring (Saugus, MA)
- …in the Right Place. **Job Description:** ** ** **Hospice Registered Nurse (RN) Case Manager** **Full-Time | Monday-Friday, 8a-5p |** At **Elara Caring** , we believe ... the place they call home. As a **Hospice RN Case Manager** , you'll guide patients and families through...most meaningful moments. You'll coordinate compassionate, patient-centered care and lead a team of dedicated professionals who make a… more
- Boston Health Care for the Homeless Program (Boston, MA)
- …medical illnesses with primary and mental health care, substance use treatment, and case management while addressing social determinants of health needs. We are ... health strategies including select quality improvement initiatives. You will lead staff participation in case conferences with...to bring RN perspective to program decisions. + Provides clinical oversight to case managers for their… more
