- 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
- Children's Hospital Boston (Boston, MA)
- 80451BRJob Posting Title:Per Diem RN Case Manager , Utilization Management /ReviewDepartment:Patient Services-Patient Care ... Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Office/Site Location:BostonRegular, Temporary, Per Diem:Per Diem… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... compliance reviews as needed. + Continuously monitors regulatory requirements for Utilization Management . + Attends Mandatory Education programs required by… 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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …transform healthcare? Bring your true colors to blue. The Role:The Medical Clinical Program Manager will focus on utilization management compliance and audit ... 's (HMM) and delegate's compliance with the applicable NCQA utilization management standards and state and federal...of HMM Quality and Compliance team, the Clinical Program Manager works through the influence as an individual contributor… more
- Children's Hospital Boston (Boston, MA)
- …+ Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current Massachusetts license as a ... the concurrent review process for acute psychiatric care + Possessing experience in Utilization Management / Utilization Review + Demonstrating the ability to… more
- Tufts Medicine (Burlington, MA)
- …with the coordination of the Utilization Management Committee. The Utilization Management Operations Manager follows the system's Utilization ... to Utilization Review departments and UM vendor management . The UM Operations Manager is responsible...the Utilization Management Plan and assisting… more
- Beth Israel Lahey Health (Burlington, MA)
- …of three years of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated ... a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:**...to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and… more
- Beth Israel Lahey Health (Plymouth, MA)
- …years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding ... + Collaborates with the multidisciplinary team to assess and improve the denial management , documentation, and appeals process. + Collaborates with UR Manager … more
- Beth Israel Lahey Health (Plymouth, MA)
- …years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding ... + Collaborates with the multidisciplinary team to assess and improve the denial management , documentation, and appeals process. + Collaborates with UR Manager … more
- Beth Israel Lahey Health (Plymouth, MA)
- …patient care status. This role is structured around four major functions + Utilization Management + Care Coordination + Discharge Planning + Preventing ... 3) Decreasing unit cost, 4) reducing readmissions. **Duties/Responsibilities:** **A. Utilization Management ** Performs review of anticipated admissions utilizing… more
- Hilton (Boston, MA)
- …of sustainability, supplier diversity, and responsible sourcing goals\. As a Senior Manager , Category Management , you will support HSM's customers and the ... same level and/or position within the Company\. \#LI\-REMOTE **Job:** _Supply Management , Procurement, Purchasing, and Receiving_ **Title:** _Senior Manager ,… more
- TD Bank (Boston, MA)
- …of Business:** Human Resources **Job Description:** **Department Overview:** The Senior Manager , Financial Crime Risk Management Training leads/manages a team ... risk awareness across the organization. **Depth & Scope:** + Provides people management leadership by hiring the best talent, setting goals, developing staff,… more
- Stryker (Boston, MA)
- …for upcoming application launches and upgrades into the MPS field organization **Project Management :** + Works with Senior Manager of Clinical Processes to ... MPS Managers for technical competency and business growth through increased robotic utilization . + Act as player-coach, actively engaging with MPS teams to ensure… more
- Cambridge Health Alliance (Everett, MA)
- RN Case Manager - Inpatient Case Management Everett **Requisition Number:** 8001 **Location:** CHA Everett Hospital **Work Days:** 8-4:30pm including weekend ... 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
- Molina Healthcare (Boston, MA)
- …performing one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... of illness and the site of service. **KNOWLEDGE/SKILLS/ABILITIES** The Manager , Healthcare Services provides operational management and...years in one or more of the following areas: utilization management , case management , care… more
- Beth Israel Lahey Health (Wakefield, MA)
- …just taking a job, you're making a difference in people's lives.** The Care Manager , RN provides care management services to the BILHPN primary care physicians ... healthy behavior. Working with the healthcare team, the Care Manager , RN monitors appropriate utilization of healthcare..., RN upholds the current standards of professional case management practice, and reports to the Manager … more
- Beth Israel Lahey Health (Wakefield, MA)
- …management services are provided to the BILHPN provider's risk populations. The Care Manager , RN provides care management services to the BILHPN primary care ... healthy behavior. Working with the healthcare team, the Care Manager , RN monitors appropriate utilization of healthcare..., RN upholds the current standards of professional case management practice, and reports to the Manager … more
- Grifols Shared Services North America, Inc (Boston, MA)
- …specified "Account List" of Health Systems designed to increase the adoption and utilization of the Grifols Bleeding Management product portfolio. The KAM's ... role in the successful launch of a new Bleeding Management product within the Grifols Biopharma portfolio. The KAM...provide any necessary support to the responsible National Account Manager (NAM) in the execution of the contracting process… more