- US Tech Solutions (Canton, MA)
- …This is Fully remote, but Massachusetts RN license required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that ... clinically complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the... functions as a member of the Precert / Outpatient UM team and works under the… more
- Fallon Health (Worcester, MA)
- …authorization process + On-site, off-site and telephonic inpatient case management rounds + Outpatient case management rounds + Provider appeals review + Member ... nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences,...director on-call coverage + Support the benefits and technology review process + Provide support for UM … more
- Children's Hospital Boston (Boston, MA)
- …Hours per Week:1 Job Posting Category:NursingJob Posting Description:Department Summary: The UM Case Managers at Boston Children's review documentation within ... resources. Key Responsibilities: + Assessing, planning, organizing and overseeing daily clinical operations of care coordination and transitions to address the… more
- Elevance Health (Boston, MA)
- …medically necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer ... Carelon Health is a proud member of the Elevance Health family of brands, offering clinical programs and primary care options for seniors. We are a team of committed… more