- Garden Place Healthcare (Attleboro, MA)
- …*Minimum of two years health care experience. *Experience with MDS completion, reimbursement, clinical resource utilization and/or case management is highly ... Medicare/Managed Care Assessments. *Tracks Skilled (MRA/HMA/HMO) customers utilizing Case Management Tools to determine continued and appropriate Medicare/Managed Care… more
- NavitsPartners (Boston, MA)
- …or case management role Demonstrated experience in discharge planning and utilization review within the past 4 years Working knowledge of InterQual(R) ... or financial needs and refer to appropriate resources Perform utilization reviews and respond to third-party payers with timely,...or equivalent clinical review system Case Management … more
- UMass Memorial Health (Worcester, MA)
- …senior management on various financial indicators, including productivity, supply utilization , and volume. Obtains data from the financial systems as needed. ... and managing the administrative/business affairs which may include billing, clinical , service and educational activities. Collaborates with appropriate leadership… more
- Lifespan (Taunton, MA)
- …director in review of financial reports, as needed. Budget Management Demonstrates appropriate utilization of staff resources, including overtime evaluation ... director in effectively managing the department within budgetary constraints. II. Leadership/ Management Skills Management , Operational, Clinical , Technical… more
- Lifespan (Providence, RI)
- …within 1 year of hire. AHA BLS Provider required. EXPERIENCE: Three years of clinical experience with recent experience in case management , community case ... Summary: Summary: Reports to the Manager or Director of Case Management . Provides coordinated care support to facilitate and expedite patient care services.… more
- US Tech Solutions (Canton, MA)
- …of clinical decision making and support needed to perform utilization management , medical necessity determinations and benefit determinations using ... remote, but Massachusetts RN license required.** **Job Summary The Clinical Reviewer is a licensed professional -a...unrestricted Massachusetts license required + Minimum of five years clinical experience in utilization management ,… more
- Commonwealth Care Alliance (Boston, MA)
- … Utilization Management reports to the Director of Utilization Management * Oversees clinical decision review for services requiring prior ... for overseeing and managing the daily operation of the Utilization Management Review Nurse and... Nurse and Specialist staff responsible for conducting centralized clinical review and authorization creation for centrally… more
- Evolent (Providence, RI)
- …from providers per guidelines. + Utilizing clinical guidelines approved by the Utilization Management Committee (UMC), the URN has the authority to authorize ... cost-effective care. **Collaboration Opportunities** : As a Radiation Technologist in the Utilization Management department, you will work closely with other… more
- Commonwealth Care Alliance (Boston, MA)
- … and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is...direct reports. **Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior… more
- Actalent (Boston, MA)
- …with all company policies and standards. Essential Skills + Proficiency in clinical review , case management , utilization review , and utilization ... Clinical Review Clinician Job Description As... Clinical Review Clinician Job Description As a Clinical...Medicare, and Medicaid regulations is preferred. + Familiarity with utilization management processes is preferred. + State… more
- Commonwealth Care Alliance (Boston, MA)
- …local regulatory guidelines. + Serve as the lead for CCA's Utilization Review functions working closely with other medical management team members. + Support ... review findings, actions, and outcomes in accordance with Utilization + Management policies; meets health plan...a clinical resource and coach for the utilization management team + Is available and… more
- Evolent (Providence, RI)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready ... make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management...within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure… more
- Evolent (Providence, RI)
- …clinical expertise in developing cardiovascular programs that include improvements to clinical effectiveness of utilization management (UM) and risk-based ... critical role in **Performance Suite risk arrangements with payers and strategic utilization management initiatives.** This is an opportunity for a… more
- Humana (Providence, RI)
- …Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Providence, RI)
- …Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical ... daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Providence, RI)
- …Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Children's Hospital Boston (Boston, MA)
- …Posting Title:Per Diem RN Case Manager, Utilization Management /ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard ... + Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current Massachusetts license… more
- Insight Global (Boston, MA)
- Job Description Insight Global is sourcing for a Utilization Management Director to join a not-for-profit community based healthcare organization within the ... federal, state, and local regulatory guidelines. -Support the development of utilization management policy initiatives. -Support the development and… more
- WTW (Boston, MA)
- …reviewed including master templates and client specific responses + Collaborate with health management senior reviewer and Project Manager to conduct follow up ... + Health analytics experience preferred + Understanding of health plan utilization /case management processes, network management , credentialing, quality… more
- Humana (Providence, RI)
- …role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with ... + Lead an operational team of Medical Directors to review authorizations and ensure clinical decision-making skills...efforts to improve the efficiency of health plan operations ( utilization management and provider clinical … more
