- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …adjudicate these requests. At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical ... Bring your true colors to blue. The Role The Physician Reviewer is responsible for evaluating clinical..., in partnership with case managers + Participate in Physician Psychologist Review Units' appeal process of… more
- Fallon Health (Worcester, MA)
- …on an interdisciplinary care team that may include the member's primary care physician , medical providers, behavioral health providers, state agencies and/or ... **Brief Summary of Purpose:** The Accountable Care Organization (ACO) Behavioral Health Case Manager (BHCM) is an...Health Pharmacist, referring members in need of medication review based upon Program process + Develops and fosters… more
- Veterans Affairs, Veterans Health Administration (Providence, RI)
- … Health Professional Trainees. Participate in performance improvement activities, physician peer review , and committees as assigned. Recruitment/Relocation ... and General Outpatient. The Staff Psychiatrist positions are located in the Mental Health & Behavioral Sciences Service (MHBSS) of the VA Providence Healthcare… more
- Monte Nido (Dedham, MA)
- …passionate about delivering high-quality, patient-centered care in a collaborative behavioral health setting. **Pay:** $225,000.00-$275,000.00 depending on ... in the state of Massachusetts (or ability to obtain). + Experience in behavioral health , eating disorder treatment, or hospital-based medicine is preferred but… more
- OptiMindHealth (Needham, MA)
- …Part-Time FLSA Status: Non-Exempt Location: Needham, MA Join a leading clinician-led behavioral health company today! OptiMindHealth (OMH) is expanding and ... seeking compassionate professionals to join our team. Today, OMH provides superior behavioral health services to patients in Massachusetts, Colorado, and… more
- Hartford HealthCare (Putnam, CT)
- …providing unparalleled access to specialty services and resources o Easy access to* Behavioral Health *, High Risk Nurse Care Managers & Social Workers ... Care Position Details:* ** * o *Role*: Primary Care Physician (18 ) o *Location*: Putnam, CT o *Setting*:...Hospitals to Work for in Connecticut" - Becker's Hospital Review o "America's Most Innovative Companies 2023" - Fortune… more
- Highmark Health (Providence, RI)
- …as first line reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. The incumbent responds ... to physician and pharmacy network provider inquiries concerning oral, injectable...+ Prioritize requests for drug authorizations or denials. + Review of prior authorization criteria for drug products. +… more
- Fallon Health (Milford, MA)
- …care including but not limited to working with providers to arrange medical and behavioral health appointments and following up with members afterwards to ensure ... + If working on the NaviCare Member Population: Facilitates transportation to medical, behavioral health , and social appointments by educating the member about… more
- CenterWell (Taunton, MA)
- … in evaluating the patient's level of function. + Confer with the patient's physician and other health care team members and participate in development/revision ... **Become a part of our caring community and help us put health first** $5K Sign on Bonus Available As a therapist at CenterWell Home Health , you'll play a vital… more
- Highmark Health (Providence, RI)
- …URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the multidisciplinary ... **Job Description :** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with… more
- Highmark Health (Providence, RI)
- …This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent ... evaluates clinical information provided by the physician against medical policy criteria. The incumbent then uses his/her clinical knowledge compared to the policy… more
- Highmark Health (Providence, RI)
- …Registered Health Information Associate (RHIA) + Certified Coding Specialist Physician (CCS-P) + Certified Professional Coder (CPC) + Certified Outpatient Coder ... **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This...:** **GENERAL OVERVIEW:** This job performs thorough medical record review to abstract medical and demographic data, interpret and… more
- Highmark Health (Providence, RI)
- …units that may assist in the resolution of issues or problems. + Access, review , utilize, contribute content to and participate in the maintenance of the shared ... Informatics Intellectual Capital Repository to include but not limited to, review /editing of content submissions and best practices, audit reports, etc. The… more
- Highmark Health (Providence, RI)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This job performs thorough medical record review to abstract medical and ... days. **ESSENTIAL RESPONSIBILITIES** + Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD… more
- Highmark Health (Providence, RI)
- …**Job Description :** **JOB SUMMARY** This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as ... projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC...+ Assists with Regulatory Audits by performing first coding review and ranking of charts. Build partnerships and work… more
- Sevita (Easton, MA)
- …treatment to individuals served + Complete health assessments and provide input of health diagnosis to RN or physician for the development of nursing care ... and personal care services under the direction of a registered nurse or physician to address the medical or psychiatric needs of individuals with developmental… more
- Evolent (Providence, RI)
- …which includes our medical reviews: LVNs, LPNs, and RNs along with our behavioral health reviewers: LMSWs, LCSW, and LPCs, Clinical Reviewers. Opportunities to ... to determine if submitted requests require a prior authorization review or redirect as required. + Entering data into...proprietary system generating cases for both the medical and behavioral health reviewers. These requests may be… more
- Sevita (Brockton, MA)
- MENTOR Adult Day Health , a member of the Sevita family, provides day programs for elders with complex medical or rehabilitative needs. This allows seniors to obtain ... a **dynamic Registered Nurse** to join our Adult Day Health team! We are looking for a **reliable self-starter**...lives of those we serve. **What You'll Do** + Review and update patient medical records. + Provide treatment… more
- Tufts Medicine (Boston, MA)
- …therapeutics. Our studies explore a range of topics including the behavioral and psychological symptoms of dementia, disease-modifying therapies, and emerging ... to human subjects' protections. 6. Responsible for assisting with Institutional Review Board (IRB) requirements for each study including meeting institutional… more
- Fresenius Medical Center (Webster, MA)
- …Human Behavior and accepted methods of social work practice. Works with the health care team to promote positive adjustment, rehabilitation and improved quality of ... team, informs, educates and supports staff in understanding the emotional, psychological and behavioral impact of Chronic Kidney Disease on the patient and family to… more