- Fallon Health (Worcester, MA)
- …more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn. The UM Nurse uses a multidisciplinary approach to organize, coordinate, monitor, ... complex medical and psychosocial needs of FH members and their families. The UM Nurse is responsible for assuring the receipt of high quality, cost efficient… more
- Baystate Health (Springfield, MA)
- **Position** Licensed Practitioner Nurse **SCHEDULE:** + Full tim + Monday - Friday + No weekends no holidays **LOCATION** : + Springfield, MA The Licensed Practical ... Nurse (LPN) functions under the supervision and guidance of...clinical liaison between the primary care team and HNE UM staff. Under the direction of an RN, the… more
- Humana (Boston, MA)
- …+ Serves as subject matter expert on NCQA Health Plan Accreditation UM requirements, advising stakeholders on compliance, and facilitating NCQA UM ... to Utilization Management and/or Behavioral Health. + Detailed working knowledge in UM Timeliness Monitoring and Reporting + Working knowledge using Power BI +… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …+ Apply their clinical knowledge when assessing/auditing medical records and UM letters against medical necessity criteria and accreditation and regulatory criteria ... Strong clinical skills and understanding of CMS Part C guidance including UM operational procedures, and CMS guidance including coverage and benefit conditions… more
- Humana (Boston, MA)
- …Full-Time Remote, Telephonic RN opportunity. The Utilization Management Behavioral Health Nurse utilizes behavioral health knowledge and skills to support the ... clinical and Utilization Management experience. The Utilization Management Behavioral Health Nurse completes medical record reviews from medical records sent from… more