- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …years of clinical experience in Behavioral Health Care settings + Utilization Management experience preferred + CCM or other applicable certification(s) ... your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care...management system, MedHOK What You Bring : + Behavioral Health professional with an active independent Massachusetts license:… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for our Medicare ... our Hingham, MA office. Hours of work: 8:30a - 4:30p EST. The TeamThe Clinical Utilization Reviewer is part of a highly dedicated and motivated team of… more
- Humana (Boston, MA)
- …health plan operations, such as provider relations, claims submission and payment, utilization management processes, behavioral health processes, and dispute ... owner content reviews and tracking documents through the internal review process. **Use your skills to make an impact**...educational material, or trainings. + 3+ years of project management experience with mid-size projects. + 2+ years of… more
- Highmark Health (Boston, MA)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- State of Massachusetts (Brockton, MA)
- …(HSC Is) to ensure compliance with DMH Regulations, policies, and procedures. * Conduct utilization management reviews as well as audit and approve monthly case ... management billing. * Review case ...staff have direct communication with Mobile Crisis Intervention (MCI), Behavioral Health Helpline &/or 911 as well as complete… more
- Beth Israel Lahey Health (Woburn, MA)
- …plans since last appointment were followed and results are available for physician review o Confirms that lab and other ancillary tests are performed and results ... health data for identified patient populations o Monitors patient progress by utilization of disease specific registries to proactively reach out to patients to… more
- Highmark Health (Boston, MA)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Elevance Health (Woburn, MA)
- …or regulation, must be in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... will be responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and...+ Background in Internal Medicine is strongly preferred. + Utilization management experience is a PLUS. Please… more
- Highmark Health (Boston, MA)
- …Description :** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent ... a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical review ,...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Beth Israel Lahey Health (Beverly, MA)
- …plans since last appointment were followed and results are available for physician review Confirms that lab and other ancillary tests are performed and results ... registry health data for identified patient populations Monitors patient progress by utilization of disease specific registries to proactively reach out to patients… 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 ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Beth Israel Lahey Health (Burlington, MA)
- …manager. . Assists Utilization Managers with all aspects of utilization review /discharge planning/performance improvement processes. . Functions as liaison ... Rightfax, NaviHealth, Change Healthcare, Epic, etc. . Manages all utilization management work queues by researching and.... Complies with all Lahey Clinic Policies. Complies with behavioral expectations of the department and Lahey Clinic. .… more
- OptiMindHealth (Boston, MA)
- …FLSA Status: Non-Exempt Location: Boston, 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 Montana. Since… more
- Beth Israel Lahey Health (Charlestown, MA)
- …to the accounts payable payment reporting and control function. Activities include: utilization of ERP system to: review daily payment/banking information loads, ... correct or release data into the ERP system upon verification, review payment forecasts, offset credit balances against applicable debits, review payment… more
- The Home for Little Wanderers (Dorchester, MA)
- …documentation and billing in a timely manner. Ensure that documentation meets utilization review and quality assurance standards. + Attend staff meetings. ... certain medical criteria. This program is part of the Massachusetts Children's Behavioral Health Initiative (CBHI). Our two CSA programs together serve Dorchester,… more
- Monte Nido (Waltham, MA)
- …may substitute leadership experience elsewhere. + Working knowledge of admissions and intake, Utilization Review , and 3rd party or insurance payers. + Previous ... are seeking a Clinical Director to work at Walden Behavioral Care located in Waltham, MA. The **Clinical Director**...Equity and Inclusion practices + Employee selection and performance management experience are a plus. + Must hold a… more
- Elevance Health (Woburn, MA)
- …preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For ... necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts peer-to-peer… more
- The Home for Little Wanderers (Waltham, MA)
- …documentation and billing in a timely manner. Ensure that documentation meets utilization review and quality assurance standards. + Meet billing requirements ... and via telehealth. **How You'll Be Making a Difference** + Provide case management services; act as a liaison with collateral agencies and programs; establish and… more
- East Boston Neighborhood Health Center (East Boston, MA)
- …Quality Outcome Measures. Other Outcome responsibilities: facilitate the monthly Clinical Quality Management meetings in Project Shine, review data for HRSA ... procedures, and professional standards. Participates in Project Shine's Quality Management Projects. Provides administrative supervision to non-clinical staff, at… more
- Westborough Behavioral Healthcare Hospital (Westborough, MA)
- …+ Tuition Reimbursement + Health Savings Account Summary: To provide quality case management , utilization review and psychotherapeutic services to all ... to our patients and their families. Who are we: Westborough Behavioral Healthcare Hospital (WBHH) provides psychiatric stabilization diagnosis treatments for Adult… more