- 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
- Tufts Medicine (Burlington, MA)
- …**Job Overview** The position provides day to day support and oversight to Utilization Review departments and UM vendor management. The UM Operations ... is responsible for compliance with CMS Conditions of Participation regarding Utilization Review and Discharge Planning including implementation and annual … 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
- Charter Care Health Partners (North Providence, RI)
- …experience that includes recent experience with case management, patient navigation, case management, utilization review or discharge planning is ... specific patient population. Performs functions related to Patient Advocacy; Utilization Review ; Resource Management; Continuum of Care...Case Management (CCM) (R) board certification or Accredited Case Manager (ACM (TM) ) is highly… 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 (Providence, RI)
- …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 (Providence, RI)
- …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 (Providence, RI)
- …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 (Providence, RI)
- …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
- 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 (Providence, RI)
- …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
- …and advising subordinates as necessary. Resolving routine personnel problems. Authorize and review utilization of home health nursing, social work, occupational, ... quality and safety, is looking for a** **Clinical Nurse Manager ** **to join our** **Home Health** **team!** **Why choose...speech therapy for medical necessity and appropriateness of care. Review plans of care to ensure functional outcomes and… more
- CVS Health (Woonsocket, RI)
- …for deliverables, capture weekly progress, and finalize test analysis reports for leadership review ; track case pipeline in Salesforce and delegate tasks to team ... Health company, is hiring for the following role in Woonsocket, RI: Sr. Manager , Client Benefits Testing to Analyze and coordinate project planning and technical… more