- 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 (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 ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager...administration or related field preferred or commensurate experience and Case Management Certification required + Minimum of 3 years… 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
- Healthfirst (MA)
- …across a variety of treatment settings for high risk, complex populations + Certified Case Manager + Interqual, Milliman, and/or TruCare knowledge + Knowledge of ... preauthorization of outpatient or inpatient services + Knowledge of utilization management/quality management case philosophies and reporting requirements… 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
- Beth Israel Lahey Health (Plymouth, MA)
- …weekend. One summer and one winter holiday. **Job Description:** The Emergency Department Case Manager is responsible and accountable for patient trajectory by ... identify the most appropriate level of care while facilitating throughput. The ED Case Manager will assist in identifying patients appropriate for Admission,… 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
- Baystate Health (Springfield, MA)
- The **RN Hospital Case Manager ** is a registered nurse responsible for the coordination of clinical care, quality, and financial outcomes of a designated ... population of patients. The Hospital Case Manager is responsible for overseeing an...+ Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by… 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
- Brockton Hospital (Brockton, MA)
- …accepted criteria and guidelines to conduct review of inpatient admissions. The Case Manager at Brockton Hospital serves as the primary liaison between ... of five years clinical experience in an acute care facility required. Prior experience in case management, utilization review or discharge planning required. 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
- Sevita (Springfield, MA)
- …join our mission-driven team and experience a career well lived. **Foster Care Case Manager Supervisor** Are you an experienced social worker/therapist with ... + May develop and implement crisis intervention emergency procedures, oversee Utilization Review , Quality Assurance, investigations, and internal evaluations. +… more
- Sevita (Worcester, MA)
- …receipt from accounting staff; identify any discrepancies to accounting staff + Coordinate utilization with the Case Manager relative to program ... who are trained to provide individual assistance to each person we serve. ** Case Coordinator** **- Adult Day Health** Location: Renaissance Adult Day Address: 1040… more
- Beth Israel Lahey Health (Wakefield, MA)
- …engagement in healthy behavior. Working with the healthcare team, the Care Manager , RN monitors appropriate utilization of healthcare resources, promotes quality ... disability. The Care Manager , RN upholds the current standards of professional case management practice, and reports to the Manager of Care Management. **Job… more
- Beth Israel Lahey Health (Wakefield, MA)
- …engagement in healthy behavior. Working with the healthcare team, the Care Manager , RN monitors appropriate utilization of healthcare resources, promotes quality ... disability. The Care Manager , RN upholds the current standards of professional case management practice, and reports to the Manager of Care Management.… more