- 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
- 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
- Red River (Boston, MA)
- **Position Summary:** The Manager , Residency Services reports to Director of Professional Services. Responsibilities include: Identifying new Residency Services ... further our Corporate Mission, Values and Objectives. Red River's Residency Services Manager will be responsible for our residents' growth and operational … 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
- 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
- Stratasys (Waltham, MA)
- Customer Success Manager Location: Waltham, MA, US Job ID: 54474 Category: Sales and Business development **Stratasys is a world leader in 3D printing!** ... to manufacturing and supply chains, and improve patient care. **Software Customer Success Manager ** . This role is pivotal in ensuring our customers achieve success… more
- Commonwealth Care Alliance (Boston, MA)
- …- Reporting to a member of Care Delivery Leadership, the Primary Care Nursing Manager is the nursing leader of the practice. Responsible for all nursing and nursing ... support functions within the practice, the Primary Care Nursing Manager will collaborate closely with other members of the... will collaborate closely with other members of the management team. This role is full-time on site in… more
- Endo International (Worcester, MA)
- …and maintain call objectives for geography with minimal consultation with Area Sales Manager (ASM) to assure proper portfolio balance and planned actions. + Develop ... maintain performance guidelines for the following metrics: call activity, appropriate utilization of samples, Quarterly Business Plan update. + Incorporate and… more
- Parexel (Boston, MA)
- …of quality worldwide meeting venues . Working knowledge of virtual meeting management and platforms . Experience working with Cvent platform a plus **Client ... relationship management ** . Proactively manages Client expectations and ensures delivery...Completes/approves project related expense claims **Metrics for success** . Utilization /billability target . Contribution to achievement of project, team,… more
- Commonwealth Care Alliance (Boston, MA)
- … management and team-building skills - Telehealth - Practice Manager experience - Bilingual or Multilingual Strongly Preferred: Spanish **Compensation ... providing primary care, palliative care and community intensive care management to a specific panel of high risk and...of Care Delivery. programs. Under the supervision of the Manager of Patient Access Operations and in direct partnership… more
- Commonwealth Care Alliance (Boston, MA)
- …and provider relationship management tools. - Understanding of claims operations, utilization management , and quality programs as they relate to provider ... engagement, delegation partnerships, provider services, contracting, quality, compliance, medical management , and analytics teams to advance provider network operations,… more
- Commonwealth Care Alliance (Boston, MA)
- …Community Health Workers (CHWs) are key supports to interdisciplinary care management teams and complement and support enrollees' needs, goals, and preferences. ... skills to improve CCA enrollee outcomes by impacting care access and utilization , closing care quality gaps, and optimizing member connection to medical, behavioral… more
- 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
- 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
- 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
