- Commonwealth Care Alliance (Boston, MA)
- 021350 Clin Alli-Care Delivery Administration Position Summary: The Director , Behavioral Health Care Delivery is responsible for the strategy and leadership of CCA's ... in all CCA Care Delivery programs with BH components.The Director will collaborate closely with the Care Delivery Leadership...populations - Knowledge of BH & SUD care delivery systems and levels of care across the state. -… more
- Commonwealth Care Alliance (Boston, MA)
- 011230 CA-Provider Engagement & Performance Position Summary: The Director of Provider Relations leads the strategic vision and operational execution of provider ... network performance, and ensuring compliance with regulatory standards. The Director drives initiatives that enhance operational engagement, member access, provider… more
- Commonwealth Care Alliance (Boston, MA)
- …Abilities & Language (nice to have):** + Familiarity with care management and utilization management systems and workflows for populations with complex medical, ... performance improvement. The LTSS Program Manager reports to the Senior Director of Delegation Partnerships and Provider Engagement. The Provider Engagement team… more
- Commonwealth Care Alliance (Boston, MA)
- …manager, and performance partner - using data, provider feedback, and system collaboration to enhance provider engagement, improve outcomes, and strengthen ... quality care. The BH Provider Engagement Program Manager reports to the Director of Delegation Partnerships and Provider Engagement. Supervision Exercised: - No,… more
- Commonwealth Care Alliance (Boston, MA)
- …compliance. The Senior Business Analyst, Clinical Operations reports to the Director , Clinical Operations Support. This role will provide significant BA support ... **Reports and Tools** + Engages with stakeholders to understand current processes/ systems and pain points as well as elicit detailed business needs… more
- Tufts Medicine (Burlington, MA)
- …Description** **Minimum Qualifications:** 1. Bachelor of Science in Nursing (BSN). 2. RN Licensure. 3. Current certification in case/ utilization management (ACM, ... MA. **About Tufts Medicine:** Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver… more
- Cognizant (Boston, MA)
- …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...submit the medical necessity determinations to the Health Plan/Medical Director based on the review of clinical documentation in… more
- Beth Israel Lahey Health (Cambridge, MA)
- …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 ... on the key performance indicators and quality measures, the RN specialist also aims to foster a culture of...reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts,… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... PURPOSE OF POSITION: The Director of Case Management is responsible for planning,...monitoring mechanisms to identify areas for improvement of resource utilization . Plans and develops systems and processes… more
- Commonwealth Care Alliance (Boston, MA)
- 011230 CA-Provider Engagement & Performance Position Summary: The Director of Provider Relations leads the strategic vision and operational execution of provider ... network performance, and ensuring compliance with regulatory standards. The Director drives initiatives that enhance operational engagement, member access, provider… more
- Commonwealth Care Alliance (Boston, MA)
- 021350 Clin Alli-Care Delivery Administration Position Summary: The Director , Behavioral Health Care Delivery is responsible for the strategy and leadership of CCA's ... in all CCA Care Delivery programs with BH components.The Director will collaborate closely with the Care Delivery Leadership...populations * Knowledge of BH & SUD care delivery systems and levels of care across the state. *… more
- Erickson Living (Hingham, MA)
- …Linden Ponds by Erickson Senior Living Join our team as the Assistant Director of Nursing is responsible for clinical leadership and outcomes within our Skilled, ... and dehydration. + Participating in Wound Rounds, Operations Meetings, Utilization Review, and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee. +… more
- Evolent (Boston, MA)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... seek to connect the pieces of fragmented health care system and ensure people get the same level of...precertification and prior approvals. Tasks are performed within the RN /LVN/LPN scope of practice, under Medical Director … more
- Beth Israel Lahey Health (Boston, MA)
- …Nursing Program required. Baccalaureate degree in Nursing strongly preferred. + License Registered Nurse required. + American Heart Association - Basic Life ... and Emergency Department. In absence of Admission Facilitator, directs bed utilization . + Provides clinical consultation, support, education and mentoring to… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... Completes medical literature searches and/or coordinates appropriate provider-to-payer medical director discussions. + Collaborates with attending physicians on treatment… more
- Commonwealth Care Alliance (Boston, MA)
- …manager, and performance partner - using data, provider feedback, and system collaboration to enhance provider engagement, improve outcomes, and strengthen ... quality care. The BH Provider Engagement Program Manager reports to the Director of Delegation Partnerships and Provider Engagement. Supervision Exercised: * No,… more
- Beth Israel Lahey Health (Charlestown, MA)
- …& Abilities:** * Must have sound understanding of ICD-10, and CPT coding systems ; prospective reimbursement system . * Ability to review and analyze issues ... **Essential Duties & Responsibilities** including but not limited to: * Maintain a system of reporting that provides timely and relevant information on all aspects… more
- Beth Israel Lahey Health (Boston, MA)
- …Schedules follow-up tests and appointments using hospital or Clinical Research Center (CRC) systems . Collaborates with RN on executing a participant's care plan. ... works under the direction of the research study investigators, study physician and/or nurse to perform clinical activities in the context of a research protocol.… more
- Beth Israel Lahey Health (Milton, MA)
- …for all. Beth Israel Milton is currently seeking a full-time Emergency Department Nurse . POSITION FUNCTION: In collaboration with the Director oversees daily ... AND RESPONSIBILITIES: . Under the general supervision of the Director supports and supervises with-in the framework of the... supports and supervises with-in the framework of the RN license, maintains the standards of practice and evaluates… more
- Commonwealth Care Alliance (Boston, MA)
- …this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. ... financial ability and forecasting for small to large Operations Management + Collaborate system and data configuration into CES (Claims Editing System ) with… more
