- Beth Israel Lahey Health (Burlington, MA)
- …you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered ... Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality...Case Manager experience as well as Utilization Review experience ( review medical… more
- Children's Hospital Boston (Boston, MA)
- 80451BRJob Posting Title:Per Diem RN Case Manager , Utilization Management/ReviewDepartment:Patient Services-Patient Care ... required, pediatric experience preferred. + Experience as a Case Manager (Discharge Planning and or Utilization Management) preferred. Licensure/… more
- Beth Israel Lahey Health (Burlington, MA)
- …collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities ... Duties & Responsibilities** _including but not limited to:_ + Ensures that Utilization Review nurses are consistently recommending the appropriate admission… more
- Commonwealth Care Alliance (Boston, MA)
- …Knowledge, Skills & Abilities (must have): * Expertise in managing utilization review processes including prior authorization, concurrent and retrospective ... facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing...for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring...RN **Desired Licensing (nice to have):** + CCM (Certified Case Manager ) **Required Experience (must have):** +… more
- Sevita (Marlborough, MA)
- …receipt from accounting staff; identify any discrepancies to accounting staff + Coordinate utilization with the Case Manager relative to program ... trained to provide individual assistance to each person we serve. **Bilingual (Mandarin) Case Coordinator** **- Adult Day Health** Location: Aging Well Adult Day Care… more
- Beth Israel Lahey Health (Wakefield, MA)
- …engagement in healthy behavior. Working with the healthcare team, the Care Manager , RN monitors appropriate utilization of healthcare resources, promotes quality ... disability. The Care Manager , RN upholds the current standards of professional case management practice, and reports to the Manager of Care Management. **Job… more
- Molina Healthcare (Cambridge, MA)
- …experience. **Preferred License, Certification, Association** Any of the following: Certified Case Manager (CCM), Certified Professional in Healthcare Management ... performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.),… more
- Highmark Health (Boston, MA)
- …Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/ case … more
- Highmark Health (Boston, MA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/ case … more
- Lawrence General Hospital (Lawrence, MA)
- …referrals and facilitates appropriate discharge plans. + Works in conjunction with Utilization Review Nurse, Social Worker and Clinical Care Leader to ... As the Complex Care Nurse Manager provides evidence-based assessments, tools, information, and resources...setting with discharge planning, continuing care, care management, and utilization review . + Five years clinical nursing… more
- Federal Home Loan Bank of Boston (Boston, MA)
- Project Portfolio Manager Location Boston Apply Now (https://phh.tbe.taleo.net/phh01/ats/careers/v2/applyRequisition?org=FHLBBOSTON&cws=38&rid=435) Project Portfolio ... Summary This is a newly created position at the Bank. The Project Portfolio Manager will lead our project management team and oversee the project managers over… more
- Riverside Community Care (Lynnfield, MA)
- …and administrative oversight for assigned clinicians, including case consultation/ review , ongoing clinical supervision, utilization review /clinical ... Riverside Community Care Love what you do! Clinical Team Manager - Lynnfield Outpatient Riverside seeks a Clinical Team Manager for the Lynnfield Outpatient… more
- Bright Horizons (Newton, MA)
- The Talent Acquisition Optimization Manager is responsible for driving the efficiency and effectiveness of the talent acquisition process through the implementation ... Managing the execution of system enhancements, including planning, development, and review of required training and communication materials. + Training and Change… more
- Nestle (Sudbury, MA)
- …+ Risk Assessment and Elimination - Leads the effective implementation and utilization of risk assessment and risk prediction processes across sites to ensure ... recurrence are effectively implemented while also ensuring an effective injury case management process is fully implemented, well understood, and functioning as… more
- Evolent (Boston, MA)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical...and findings with matrixed Physician Business Manager . + Provides medical direction to… more
- Beth Israel Lahey Health (Boston, MA)
- …completing all required fields, communicating to the appropriate personnel, and entering the case into the OR Manager system, utilizing all proper codes for ... Charge and Anesthesia, but is ultimately responsible to the OR Nurse Manager . **Job Description:** PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS: 1. Exemplifies the… more
- Triangle Inc. (Salem, MA)
- …+ Manages caseload of DDS, MRC, and private pay clients + Consults with Site Manager and staff to ensure consistent case management practices are followed + ... Position: Human Services Program Coordinator Reports to: Human Services Site Manager Hours: Full-time/Salaried , M-F, 8am-4:30pm Location: Salem Day Services Tria… more
- Tufts Medicine (Burlington, MA)
- …cooperation with multiple revenue cycle and hospital departments, such as Coding, Utilization Management (UM), Case Management, Quality and Physician advisors ... and evaluate the CDI program. This includes management of case mix index (CMI), length of stay (LOS), Observed...and leaders. The Director oversees the manager and clinical documentation specialists (CDSs) in planning, implementing… more
- WellSense (Boston, MA)
- …and monitoring of caseloads to ensure timely and effective service delivery. + Review and provide feedback on case documentation and other responsibilities to ... reporting. The Supervisor also oversees care coordination activities, including case assignment, caseload supervision, referral management, and post-discharge follow-up… more