- 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 ... for managing a clinically complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical… more
- Children's Hospital Boston (Boston, MA)
- …Title:Per Diem RN Case Manager, Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard Hours per ... Posting Description:Department Summary: The UM Case Managers at Boston Children's review documentation within 1 business day of patient admission to assess… more
- CVS Health (Providence, RI)
- …Health Counselor **Preferred Qualifications** + Crisis intervention skills preferred Managed care/ utilization review experience preferred. + Case management and ... **What you will do** + Through the use of clinical tools and information/data review , conducts comprehensive...discharge planning experience preferred. + Managed care/ utilization review experience preferred. **Education** + Minimum… more
- CVS Health (Providence, RI)
- …and optimal, cost-effective outcomes. Assessment of Members: Through the use of clinical tools and information/data review , conducts comprehensive assessments of ... participate with their provider in healthcare decision-making * Analyzes all utilization , self-report and clinical data available to consolidate information… more
- Humana (Providence, RI)
- …insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review … more
- Humana (Providence, RI)
- …insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review … more
- Humana (Providence, RI)
- …insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, ... this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of… more
- Molina Healthcare (Boston, MA)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/ outpatient medical ... at the right place at the right time and assisting them to achieve optimal clinical , financial, and quality of life outcomes. + Responsible for clinical teams… more
- Humana (Providence, RI)
- …insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review … more
- Beth Israel Lahey Health (Needham, MA)
- … clinics at BID Needham. + The CMO provides support and leadership for Utilization Review , working closely with HIM and Case Management, chairing UR committee ... is responsible for the development, implementation and monitoring of standards of clinical practice, and for the overall integration, coordination and quality of … more
- Elevance Health (Boston, MA)
- …care experience preferred. + Inpatient psychiatric hospital experience preferred. + Utilization review management experience preferred. + Strong Microsoft Suite ... 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
- Cardinal Health (Providence, RI)
- …currently have a career opening for a Reimbursement Solutions Analyst. **What Clinical Operations contributes to Cardinal Health** Clinical Operations is ... oversee the evaluation and clearance procedures and treatment orders in the contracted outpatient hospital setting. The goal is to provide a detailed outline of… more
- Highmark Health (Providence, RI)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the...or Public Health **EXPERIENCE** **Required** + 5 years in Clinical , Direct Patient care (hospital, outpatient , or… more
- OptiMindHealth (Needham, MA)
- …specialized in serving both adult and adolescent patients in a supportive outpatient environment. Our practice strives to improve access to holistic and ... cost-effective mental health care while supporting our clinical and administrative staff in all aspects of their work. Our team members define this work as the… more
- Monte Nido (Dedham, MA)
- …regulatory agencies. + Conduct psychosocial assessments, participate in treatment planning, utilization review , and discharge planning. + Conduct individual, ... 5-7 patients in both the partial hospital and intensive outpatient programs utilizing Family Based Treatment (FBT) methods and...mix of general programming and ARFID cases. + Provide clinical care and case management in a manner consistent… more
- State of Massachusetts (Taunton, MA)
- …and oversight of relevant medical services' related contracts. * Initiate improvements in clinical care through the review and revision of policies, development ... and treatment to all clients; reviews and authorizes the utilization of all medical support services; and administers the...the infection control program. * Chairs the Emergency Response Review Committee and oversees the Code Blue program. *… more