- Healthfirst (MA)
- … management, identifying alternative care options, and discharge planning** + **Certified Case Manager ** + **Interqual and//or Milliman knowledge** + **Knowledge ... This position is 100% Remote** **Duties//Responsibilities:** + **Provides case management services for assigned member caseloads which includes:** +… more
- Fallon Health (Worcester, MA)
- …and/or G drive. + Manage applicable queues in both the core system (QNXT UM and Call Tracking) and the case management application (TruCare). + ... **Brief Summary of Purpose:** Under the direction of the Manager of Prior Authorization, communicates with contracted and non-contracted… more
- Commonwealth Care Alliance (Boston, MA)
- …Operating Procedures + Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works with ... UM Manager and other clinical leadership to... UM Manager and other clinical leadership to ensure that departmental...RN **Desired Licensing (nice to have):** + CCM (Certified Case Manager ) **Required Experience (must have):** +… more
- Commonwealth Care Alliance (Boston, MA)
- …procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and managing the daily ... decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director of Utilization… more
- Highmark Health (Boston, MA)
- …industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create care plans ... :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over… more