- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …strategies. Your Day to Day: + With minimal oversight, leads CMS utilization management related compliance activities including: + Identify and implement ... interpret/ draw conclusions, identify gaps/ issues & analyze information from the utilization management medical management system: Care Prominence (ie… more
- Veterans Affairs, Veterans Health Administration (Brockton, MA)
- …and adjuntive staff both formally and informally as assigned for support, utilization , and management of caseloads. Work Schedule: 8:00am-4:30pm Telework: Ad-hoc ... of the open period stated in the announcement. The Assistant Program Coordinator/ Senior Social Worker (MSW) is assigned to the Psychosocial Rehabilitation and… more
- WellSense (Boston, MA)
- Nurse Care Manager ( Senior Care Product) - Field Based WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New ... Plan is recruiting for motivated, compassionate, mission-driven nurses to join our Senior Care Options (SCO) program clinical team. The SCO program is designed… more
- State of Massachusetts (Boston, MA)
- …of OR, ADS, PACU, GI and SPD and clinical management /care of patients through reports, incident/accident reports, administrative meetings, conferences. ... to departmental needs. * Collaborates with CNO on staffing patterns and cost-effective utilization of resources to meet acuity levels of patient care needs in OR,… more
- Evolent Health (Boston, MA)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... , you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Point32Health (Canton, MA)
- …management experience. Understanding of operations process, utilization management and associated regulatory and accreditation requirements. Demonstrated ... in business process change. Understanding of operations process utilization management and associated regulatory and accreditation requirements. + Preferred:… more
- Evolent Health (Boston, MA)
- …Be Doing:** As a Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Brockton Hospital (Brockton, MA)
- …with Chief Medical Officer (CMO). Develops systems to ensure optimal therapeutic drug utilization . Anticipates and creates plans to manage new drug costs and supply ... policies, state and federal regulations for all pharmacy locations, and accreditation body requirements, including Department of Public Health (DPH), Board of… more