- 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
- Children's Hospital Boston (Boston, MA)
- …psychiatric nursing experience preferred. + Experience as a Case Manager (Discharge Planning and or Utilization Management) preferred. Licensure/ ... 80501BRJob Posting Title:Behavioral Health RN Case Manager - 20hrsDepartment:Patient Services-Patient Care...process for acute psychiatric care + Possessing experience in Utilization Management/ Utilization Review + Demonstrating… more
- CVS Health (Boston, MA)
- …members. **Key Responsibilities** + This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or ... Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management....lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- CVS Health (Boston, MA)
- …care for members. - This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured ... Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management....lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC… more
- CVS Health (Boston, MA)
- …Health Counselor **Preferred Qualifications** + Crisis intervention skills preferred Managed care/ utilization review experience preferred. + Case management ... and discharge planning experience preferred. + Managed care/ utilization review experience preferred. **Education** + Minimum of a Master's degree in… more
- CVS Health (Boston, MA)
- …and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. Assessment of ... Members: Through the use of clinical tools and information/data review , conducts comprehensive assessments of referred member's needs/eligibility and determines… more
- Milford Regional Medical Center (Milford, MA)
- …with other members of the healthcare team, the Point of Entry/Emergency Department Case Manager (POE/ED CM) is accountable for coordination and facilitation of ... with knowledge of current medical care technology and ancillary supports. Previous utilization review experience preferred Must be assertive with excellent… more
- Molina Healthcare (Worcester, 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)
- …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
- 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
- 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
- Fallon Health (Worcester, MA)
- …of work to meet department needs and involvement of navigator and behavioral health case manager resources as appropriate * Ensures department team members work ... NCQA, HEDIS, CMS, State, Medicare Five Star, External Quality Review projects, etc. * Participating in the preparation of...and providers fostering collaborative working relationships * Works with Manager to recommend changes to the case … 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
- 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