- Commonwealth Care Alliance (Boston, MA)
- …services, procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and ... of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director of… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
- Elevance Health (Woburn, MA)
- ** Utilization Management Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... shift between 8 AM and 6 PM Eastern. The ** Utilization Management Representative I** is responsible for...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Cambridge Health Alliance (Somerville, MA)
- RN Case Manager - Inpatient Case Management SH **Requisition Number:** 10421 **Pay Range:** $41.58 - $93.96 per hour **Location:** CHA Somerville Campus **Work ... insurance as needed. Summary: Under the general supervision of the Director of Care Management , the RN Case Manager provides clinically-based case management … more
- Cambridge Health Alliance (Somerville, MA)
- RN Case Manager - Inpatient Case Management SH **Requisition Number:** 10379 **Pay Range:** $41.58 - $93.96 per hour **Location:** CHA Somerville Campus **Work ... Under the general supervision of the Director of Care Management , the RN Case Manager provides clinically-based...members of the health care team to identify appropriate utilization of resources and to ensure reimbursement. Utilize criteria… more
- Commonwealth Care Alliance (Boston, MA)
- …Work collaboratively with internal departments-including Clinical Operations, Contracting, Network Management , Utilization Management , and Business ... and improvement efforts. Through reporting, data analysis, and partnership management , the LTSS Program Manager ensures that...& Language (nice to have):** + Familiarity with care management and utilization management systems… more
- Beth Israel Lahey Health (Cambridge, MA)
- …Inpatient criteria approved by the MACIPA (risk) and MAH (non-risk) Utilization Management Committees to accurately determine appropriateness for inpatient ... 2. Three years of medical/surgical nursing care experience. Two years of case management or utilization management experience required. 3. Basic computer… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. * Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management * Serve as the primary relationship manager and point… more
- State of Massachusetts (Boston, MA)
- …appropriate to inform the Division's various audiences. The Director of Pharmacy Benefit Manager Oversight is a senior management level position that reports to ... Division of Insurance values inclusiveness and diversity within their employee and management teams. Within our community we strive to create and maintain working… more
- Highmark Health (Boston, MA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- Commonwealth Care Alliance (Boston, MA)
- …delegated partnerships programs, working with clinical community partners responsible for care management and utilization management across CCA's One Care ... Knowledge, Skills, Abilities & Language (nice to have): * Familiarity with care management and utilization management systems and workflows. * Experience… more
- Beth Israel Lahey Health (Needham, MA)
- …practice model. **Job Description:** **Essential Responsibilities:** 1. Performs utilization management , care coordination, and discharge planning ... (every third weekend & rotating holiday required) Job Summary: The RN Case Manager (CM) facilitates the coordination of care for those patients admitted to medical,… more
- Adecco US, Inc. (Cambridge, MA)
- …* Support documentation efforts for audit readiness and compliance reporting System Utilization * Utilize case management platforms effectively for daily ... Healthcare & Life Sciences is hiring a remote Case Manager for our Pharmaceutical partner in Cambridge, MA. The...to detail, and operational knowledge to support day-to-day case management activities. As an essential internal resource, the Case… more
- Colliers Engineering & Design (Boston, MA)
- … to lead our Civil/Site team in Boston, MA! The Department Manager is responsible for the professional, technical, management , marketing, administrative ... of work and the sharing of resources within the discipline, maximizing staff utilization . Reviews staff utilization regularly and promptly addresses staff not… more
- Amgen (Marlborough, MA)
- …playing a key role in establishing product demand and delivering comprehensive account management within a designated territory. You will serve a central point of ... patient care. As a SAM, you will drive product utilization while identifying and addressing the unique needs of...is a person with these qualifications. **Basic Qualifications (Account Manager - Level 4)** Bachelor's Degree and 3 years… more
- Burns & McDonnell (Newton, MA)
- **Description** The Transmission Department Manager is responsible for the managerial direction and leadership of the Northeast Region (NER) Transmission Department ... the following, with other duties as assigned by senior management . Fostering Culture + Drive a culture focused on...practice, regional and company objectives. + Regularly review team utilization of staff to make sure employees have a… more
- Ryder System (Boston, MA)
- …: **We are immediately hiring a Senior Continuous Improvement Logistics Manager (Engineering) in Indianapolis, IN (REMOTE) for our Supply Chain Solutions ... the use of continuous improvement methods to support new and existing operations. The Manager will manage the CI resources across the business to influence and drive… more
- State of Massachusetts (Boston, MA)
- …and dynamic individual for the position of Human Services Coordinator II (CYF Case Manager Supervisor) to join our Metro Boston Child, Youth, and Family team. The ... to DMH clients. The HSC-II has the responsibility of monitoring performance and utilization of assigned Area-based CYF contracts and serving as a Service Integration… 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 ... training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health....position consists of working intensely as a telephonic case manager with patients and their care team for fully… more
- Elevance Health (Woburn, MA)
- …services only, and there is licensed staff supervision. + Previous experience in case management / utilization management with a broad range of experience with ... **Behavioral Health - Care Manager II** **Location** : _Virtual:_ This role enables...care experience required. **Preferred Skills, Capabilities, and Experiences:** + Utilization Management experience strongly preferred. + Inpatient… more