- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe RN Utilization Management Reviewer is responsible for facilitating care for members who ... to provide the best quality care. The TeamThe RN Utilization Management Reviewer is part of a...dedicated and motivated team of professionals, including medical and behavioral health care managers, dietitians, pharmacist, clinicians,… more
- Humana (Boston, MA)
- …clinical services . Experience in utilization management review and case management in a health plan setting . No current sanction from Federal or ... part of our caring community and help us put health first** The Behavioral Health ...a focus on collaborative business relationships, value-based care, population health , or disease or care management +… more
- Sevita (Lowell, MA)
- **Mentor South Bay** , provides Early Intervention, Applied Behavioral Analysis (ABA), Behavioral Health and Mental Health Outpatient services across ... job first and foremost in accordance with the Company's mission. The Behavioral Program Supervisor is responsible for the administrative supervision and guidance of… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …Active clinical practice in order to participate in panel appeals + Experience in Utilization Management in a managed-care environment (as a clinician or in ... to evaluate clinical service requests + Practice anticipatory case management for members whose cases come for review, in...as the highest in member satisfaction among Massachusetts commercial health plans by JD Power , Blue Cross Blue… more
- Tufts Medicine (Boston, MA)
- …may impede progress. Makes recommendations to the team regarding patient/family care and management . Assists health care team to assist patient/family level of ... **Clinical Social Worker LICSW - Pediatrics: Developmental/ Behavioral Pediatrics - Boston - Sign-on Bonus Eligible** **Job Profile** **Summary** This role focuses… more
- Highmark Health (Boston, MA)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- Highmark Health (Boston, MA)
- …This role supports the full application product lifecycle for **clinical and utilization management software** , with a specific focus on driving ... function as a pivotal bridge, translating high-level **clinical and utilization management software** business needs into detailed...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Boston, MA)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... decisions, ensuring alignment with the Quadruple Aim of Healthcare: lower per capita health care costs, improved outcomes and quality of care received, and optimal… more
- Highmark Health (Boston, MA)
- …residency program + 5 - 7 years in Pharmacy + 3 - 5 years in Pharmacist - Utilization Management + 3 - 5 years in Pharmacist - Medical Therapy Management ... are transitioned to a Pharmacist for Case & Disease Management (CMDM). The incumbent then conducts thorough research to...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Boston, MA)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Boston, MA)
- …to set health goals by working cooperatively with medical providers, case management departments and/or health plans to help ensure that patients have ... **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This...resources appropriate to the needs of patients/families and ongoing utilization of resource database. (5%) + Other duties as… more
- Highmark Health (Boston, MA)
- …impact corporate performance + Researches, manipulates, and prepares data related to Health Management programs that document program activities and the results ... the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role...of Health Management… more
- CVS Health (Boston, MA)
- …. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health /Substance Abuse or Maternity/ Obstetrics experience.… more
- Boston Health Care for the Homeless Program (Boston, MA)
- …new, non-clinical, two-part role on our Street Team. This position combines complex case management within the Behavioral Health Community Partners (BH CP) ... care to cancer treatment. Our clinicians, case managers, and behavioral health professionals work in more than...Team, you will oversee outreach, enrollment, and ongoing case management for our Street Team. + Orient and train… more
- State of Massachusetts (Boston, MA)
- …contracts for Adult Community Clinical Services and PACT programs, including utilization management , fiscal oversight, billing approval, and performance ... administration and management , including supervision, program planning, communication, budgeting, utilization management , risk management , and quality … more
- Highmark Health (Boston, MA)
- …of various projects and data analysis related to Medical Policy and Utilization Management . **ESSENTIAL RESPONSIBILITIES** + Perform management ... a supervisory capacity or role **Preferred** + Experience in Utilization Management and/or Medical PolicyExperience working with...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Boston, MA)
- …supporting, and optimizing the architectural strategy for **all clinical and utilization management applications** . Their expertise spans application, solution, ... and AI integration, extending this strategic oversight across **all clinical and utilization management applications** . This involves ensuring the completeness… more
- Fenway Health (Boston, MA)
- …consistent with the care philosophy of patient-centeredness, non-judgmental, harm reduction, behavioral health integration, and team-based care. The nurse serves ... Job Type Full-time Description As a Registered Nurse (RN) at Fenway Health you will provide compassionate, evidence-based, and efficient care to individuals,… more
- Beth Israel Lahey Health (Burlington, MA)
- …System Coordinators in par level establishment and maintenance, refill process, utilization analysis and product management . -Collaborates with Purchasing Agent ... non-Pyxis product 12) Audits daily case equipment and supply utilization sheets to ensure accuracy of billing activity as...Complies with all Lahey Clinic Policies. 27) Complies with behavioral expectations of the department and Lahey Clinic. 28)… more