- 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
- Beth Israel Lahey Health (Burlington, MA)
- …making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse (RN) Case ... Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality...the Clinic to accurately determine appropriateness for inpatient and outpatient care. 3) Utilizes clinical expertise to… more
- Riverside Community Care (Lynnfield, MA)
- …oversight for assigned clinicians, including case consultation/ review , ongoing clinical supervision, utilization review / clinical documentation, ... Riverside Community Care Love what you do! Clinical Team Manager - Lynnfield Outpatient Riverside seeks a Clinical Team Manager for the Lynnfield … 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
- Lawrence General Hospital (Andover, MA)
- …disease and/or injury. + Independently performs physical therapy examination (history, system review and tests and measures) and assesses and interprets findings to ... consultation with physician by prescription. + Uses problem-solving and clinical decision-making to independently design, implement, and modify therapeutic… more
- CVS Health (Boston, MA)
- …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
- Tufts Medicine (Burlington, MA)
- …the Clinical Documentation Integrity (CDI), Coding, HIM Operations, and Utilization Review (UR) departments while implementing enterprise-wide vision. The ... collaborates with Tufts Medicine Leadership including but not limited to Clinical operations, Finance, Revenue Integrity, Patient Access; Patient Financial Services… more
- Tufts Medicine (Melrose, MA)
- …(BPS) credential in a related area of practice. 6. Experience in drug utilization review and analysis. **Duties and Responsibilities** **:** The duties and ... assigned. 1. Provides prospective evaluation and monitoring of drug therapy. 2. Coordinates review of policies and procedures related to clinical practice. 3.… more
- Cambridge Health Alliance (Cambridge, MA)
- …team leader in multi-disciplinary team discussion regarding treatment planning, treatment review , quality assurance and utilization review ... Nurse Practitioner - Clinical Specialist II (APRN), Psychiatry **Requisition Number:** CHAP-2270...and an integrated network of both primary and specialty outpatient care practices in Cambridge, Somerville and Boston's Metro… more
- Beth Israel Lahey Health (Westwood, MA)
- …to enter and access patient care information. 7. Participates in quality management and utilization review programs. 8. May coordinate the work of a small group ... part of the interdisciplinary team that includes all pharmacists (ie, clinical , production, and retail), certified pharmacy technicians, pharmacy interns, technician… more
- Sevita (Lowell, MA)
- …+ May develop and implement crisis intervention emergency procedures, oversee Utilization Review , Quality Assurance, investigations, and internal evaluations. + ... Intervention, Applied Behavioral Analysis (ABA), Behavioral Health and Mental Health Outpatient services across Massachusetts and Connecticut. For over 35 years,… more
- Veterans Affairs, Veterans Health Administration (Jamaica Plain, MA)
- …of this position is to serve as a Lead Medical Support Assistant (MSA) for Outpatient Clinical Support in the VA Boston Healthcare System. The incumbent is ... coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic schedules… more
- Veterans Affairs, Veterans Health Administration (West Roxbury, MA)
- …and controlling work for the lower graded Medical Support Assistants in their assigned outpatient clinical settings. This position is full time at 40 hours per ... of on-the-job skills, classroom instruction closely associated with actual inpatient/ outpatient hospital clinical practices, and attitudes and relationship… more
- Humana (Boston, MA)
- …this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of ... resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and… more
- Humana (Boston, MA)
- …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
- Molina Healthcare (Cambridge, 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
- 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
- Highmark Health (Boston, MA)
- …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 (Concord, 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 (Waltham, MA)
- …regulatory agencies. + Conduct psychosocial assessments, participate in treatment planning, utilization review , and discharge planning. + Conduct individual, ... + Manage a caseload of patients in both the partial hospital and intensive outpatient programs utilizing Family Based Treatment (FBT) methods. + Provide clinical … more