- Commonwealth Care Alliance (Boston, MA)
- …services, procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and ... of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director of… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
- Novo Nordisk Inc. (Boston, MA)
- …the Specialty Field Sales Representative reports to the District Business Manager of the specific sales territory. The Specialty Field Sales Representative ... productively and respectably challenge and influence target physicians' approach to patient management and adds value by sharing new information and unique insights… more
- Commonwealth Care Alliance (Boston, MA)
- …Work collaboratively with internal departments-including Clinical Operations, Contracting, Network Management , Utilization Management , and Business ... and improvement efforts. Through reporting, data analysis, and partnership management , the LTSS Program Manager ensures that...& Language (nice to have):** + Familiarity with care management and utilization management systems… more
- Jobleads-US (Boston, MA)
- LEK Consulting is a global management consulting firm that uses deep industry expertise and rigorous analysis to help business leaders achieve practical results with ... go to www.lek.com . Overview of Role The Talent Manager will play a critical role on our staffing...on our staffing team to ensure staffing and team utilization is being managed effectively in a high-paced, ever-changing… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. - Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management - Serve as the primary relationship manager and point… more
- Red River (Boston, MA)
- **Position Summary:** The Manager , Residency Services reports to Director of Professional Services. Responsibilities include: Identifying new Residency Services ... further our Corporate Mission, Values and Objectives. Red River's Residency Services Manager will be responsible for our residents' growth and operational … more
- Commonwealth Care Alliance (Boston, MA)
- …delegated partnerships programs, working with clinical community partners responsible for care management and utilization management across CCA's One Care ... Knowledge, Skills, Abilities & Language (nice to have): - Familiarity with care management and utilization management systems and workflows. - Experience… more
- Commonwealth Care Alliance (Boston, MA)
- …- Reporting to a member of Care Delivery Leadership, the Primary Care Nursing Manager is the nursing leader of the practice. Responsible for all nursing and nursing ... support functions within the practice, the Primary Care Nursing Manager will collaborate closely with other members of the... will collaborate closely with other members of the management team. This role is full-time on site in… more
- Jobleads-US (Boston, MA)
- …since 1870. Consistently recognized as one of the most reputable construction management firms in the country, Gilbane is committed to delivering projects safely ... consistency with approved rates Generate reports and dashboards to track rate utilization and financial impact Maintain documentation and records for rate approvals… more
- Commonwealth Care Alliance (Boston, MA)
- … management and team-building skills - Telehealth - Practice Manager experience - Bilingual or Multilingual Strongly Preferred: Spanish **Compensation ... providing primary care, palliative care and community intensive care management to a specific panel of high risk and...of Care Delivery. programs. Under the supervision of the Manager of Patient Access Operations and in direct partnership… more
- Parexel (Boston, MA)
- …of quality worldwide meeting venues . Working knowledge of virtual meeting management and platforms . Experience working with Cvent platform a plus **Client ... relationship management ** . Proactively manages Client expectations and ensures delivery...Completes/approves project related expense claims **Metrics for success** . Utilization /billability target . Contribution to achievement of project, team,… more
- Commonwealth Care Alliance (Boston, MA)
- …Community Health Workers (CHWs) are key supports to interdisciplinary care management teams and complement and support enrollees' needs, goals, and preferences. ... skills to improve CCA enrollee outcomes by impacting care access and utilization , closing care quality gaps, and optimizing member connection to medical, behavioral… more
- Commonwealth Care Alliance (Boston, MA)
- …and provider relationship management tools. - Understanding of claims operations, utilization management , and quality programs as they relate to provider ... engagement, delegation partnerships, provider services, contracting, quality, compliance, medical management , and analytics teams to advance provider network operations,… more
- Commonwealth Care Alliance (Boston, MA)
- …services, procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and ... of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director of… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding… more
- Beth Israel Lahey Health (Plymouth, MA)
- …its **Care Transitions Department** and seeking an experienced ** Manager of Utilization Review & Denials Management ** and ** Utilization Review** ... CCM, ACM, or other case management certification preferred or in progress ** Manager - Utilization Review & Denials Management ** This role is ideal for a … more
- Beth Israel Lahey Health (Plymouth, MA)
- …years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding ... + Collaborates with the multidisciplinary team to assess and improve the denial management , documentation, and appeals process. + Collaborates with UR Manager … more
- Beth Israel Lahey Health (Plymouth, MA)
- …patient care status. This role is structured around four major functions + Utilization Management + Care Coordination + Discharge Planning + Preventing ... 3) Decreasing unit cost, 4) reducing readmissions. **Duties/Responsibilities:** **A. Utilization Management ** Performs review of anticipated admissions utilizing… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. * Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management * Serve as the primary relationship manager and point… more
