- Commonwealth Care Alliance (Boston, MA)
- …(must have):** + RN **Desired Licensing (nice to have):** + CCM (Certified Case Manager ) **MA Health Enrollment (required if licensed in Massachusetts):** + ... Reviewer is responsible for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Utilization Management… more
- Spaulding Rehabilitation (Brighton, MA)
- Case Manager - ( 3301177 )...**Experience** Required * 5 years of related experience. * Case management, utilization review , or ... or outpatient setting is required. Preferred * Health plan experience in utilization review and case management will be considered. **Licensure** Required *… more
- Spaulding Rehabilitation (Charlestown, MA)
- Case Manager - ( 3299183 )...**Experience** Preferred * 3-5 years of related experience. * Case management, utilization review , or ... nursing or outpatient setting is required. * Health plan experience in utilization review and case management will be considered. **Licensure** Required *… more
- Sevita (Stoughton, MA)
- …receipt from accounting staff; identify any discrepancies to accounting staff + Coordinate utilization with the Case Manager relative to program ... assistance to each person we serve. **Boom Dia Adult Day is looking for a Case Coordinator. This is a M-F dayshift opportunity. Applicants are required to be fluent… more
- Brockton Hospital (Brockton, MA)
- …readmissions, improve HCAHPS, drive positive discharge outcomes and reduce LOS, and review ER utilization using proactive approaches to any barriers. The ... with the Manager of Care Coordination (or other designee) to review caseload and discuss barriers/challenges and review performance compared to current… more
- Highmark Health (Boston, MA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to assure appropriate resource utilization , identification of opportunities for referral to a Health Coach/ case … more
- State of Massachusetts (Boston, MA)
- *Executive Office of Housing and Livable Communities (EOHLC*)*is seeking a** Manager of State Individual Homelessness Resource**s in the Division of Housing ... Massachusetts communities. *_OVERVIEW OF ROLE:_* This position functions as the manager for individual shelter operations team, which oversees unaccompanied adult… more
- Boston Mutual Life Insurance (Canton, MA)
- …is responsible for managing new business and renewal assignments, quality review of case assignments, collaborating with Distribution management, reviewing ... effective utilization of monitoring standards including audit and quality review to assess underwriting results and positive loss ratios.Work with other internal… more
- Office of Personnel Management (Boston, MA)
- …sensitive aspects of the policy or program to manage controversial issues. Review and evaluate the progress of significantly important program areas, including human ... the development or modification of program objectives and resource utilization . Analyze data to identify best practices relating to...Decisions on requests for RA are made on a case -by- case basis. If you meet the minimum… more
- Confluent (Boston, MA)
- …targeting and program performance measurement. + Build, evangelize, and drive utilization of campaign briefs as well as detailed, integrated campaign playbooks, ... proposition, pre/during/post promotional strategies/tactics, long form assets (white papers, case studies, webinars), short form/promotional assets (blogs), down funnel… more
- Triangle Inc. (Malden, 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: Broadway Tria ngle's… more
- Prime Therapeutics (Boston, MA)
- …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing criteria. + At minimum ... for drug services. + Will actively maintain a required case load and the activities to reach overall goals...Quality oversight for this program is provided by the Manager , Patient Programs. **Responsibilities** + Registered Nurse (RN). +… more
- State of Massachusetts (Boston, MA)
- …as needed to ensure compliance with program rules and regulations. . Conducts review of client files, incident reports, utilization and other program ... of HomeBASE and Rapid Rehousing, the Affordable Housing and Subsidy Resource Manager and collaborates closely with the Regional Teams and Housing Search Specialists… more
- Lumen (Boston, MA)
- …be responsible for evaluating and planning optimal network solutions utilization Lumen standards, consumption trends, new technologies, industry design requirements ... installations of network standards. + Knowledge of Project Reporting - effectively review and communication of project plans and status with high clarity,… more
- WTW (Boston, MA)
- …of response and report any issues or impact to timeline proactively to Project Manager + Complete initial review of carrier responses for parity projects + ... Health analytics experience preferred + Understanding of health plan utilization / case management processes, network management, credentialing, quality… more
- The Home for Little Wanderers (Boston, MA)
- …reports, documentation and billing in a timely manner. Ensure that documentation meets utilization review and quality assurance standards. + May be required to ... are referred for the program, overseen by a contract manager at DCF Central Office. The YPC Clinician at...and within family member's homes and community. + Provide case management services; act as a liaison with collateral… more
- Beth Israel Lahey Health (Middleboro, MA)
- …Improvement and CQI issues as well as to unsafe working conditions. Notifies manager of concerns. Participates in unit based QI activities and is familiar with ... appointment were followed and results are available for physician review o Confirms that lab and other ancillary tests...Serves as a liaison with patients, families to physicians, case managers, 3rd party payers, et al. o Reviews,… more
- Beth Israel Lahey Health (Burlington, MA)
- …Improvement and CQI issues as well as to unsafe working conditions. Notifies manager of concerns. Participates in unit-based QI activities and is familiar with unit ... appointment were followed and results are available for physician review + Confirms that lab and other ancillary tests...Serves as a liaison with patients, families to physicians, case managers, 3rd party payers, et al. + Reviews,… more