- 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...and BCBSMA policies and procedures + Focus on efficient utilization management with emphasis on discharge planning… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Retail Pharmacy, Medicare Advantage Part D, Home Infusion Therapy, and Medical Utilization Management benefits. ROLE RESPONSIBILITIES: + Participation in Prior ... + Support the Home Infusion Therapy, Specialty Pharmacy Network and Medical Utilization Management for pharmaceuticals programs. + Partner with clinical and… 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
- 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
- South Middlesex Opportunity Council (Framingham, MA)
- …Director, responsible for the design, development, implementation and ongoing maintenance of Utilization Review process for all clinical services. + Engage all ... continuity of outpatient clinical services and programs provided by SMOC Behavioral Healthcare's outpatient clinics. The Director will promote communication and… more
- Advocates (Framingham, MA)
- …coordination staff. This role also provides triage and coordination of behavioral health, social services and primary physical healthcare services for individuals ... service/support. + Assist Project Director in overseeing staff workload and review documentation to ensure compliance with BHPMW standards and practices. +… more
- Monte Nido (Waltham, MA)
- …Care and the NASW. + Conduct psychosocial assessments, participate in treatment planning, utilization review , and discharge planning for an average of 8 ... the opportunity for people to realize their healthy selves. **Adult Therapist** **Walden Behavioral Care** **Virtual position** Walden Behavioral Care is one of… 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
- The Home for Little Wanderers (Roslindale, 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). The Hyde Park CSA, located in Roslindale, seeks… 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
- Beth Israel Lahey Health (Lynn, MA)
- …ensure the delivery of safe and therapeutic treatment. Demonstrates competency in utilization review and insurance authorization. Expertly plans and facilitates ... the multi-disciplinary treatment team to enhance the smooth delivery of quality behavioral health care. Requirements: Masters in Social Work or Mental Health… more
- State of Massachusetts (Milford, MA)
- …Services (ADC/Clinical Services) and provide assistance and support for contract management and quality improvement review to the Health Services ... Clinical Director and the Director of Behavioral Health. The DCC will play a critical role...will play a critical role as part of the management team that ensures the quality of contracted medical,… more
- State of Massachusetts (Boston, MA)
- …AL Unit Nurse will be the primary AL Unit staff specializing in case management review of clinical issues identified at the individual ALR-level and ... and effective internal quality reviews. Additionally, the AL Unit Nurse will review and evaluate reports with potentially related clinical issues received via the… more
- Highmark Health (Boston, MA)
- …methods and tools and ensures that they are applied effectively. + Review others' system design to ensure selection of appropriate technology, efficient use ... in business terms and values. + Manage expectations of customers and management . + Represent various architectural disciplines in customer reviews and planning,… more
- Highmark Health (Boston, MA)
- …cases, which may involve speaking with providers via phone.At times, build cases in Utilization Review system during high volume times. + Other duties as ... contribute to highest levels of performance. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities including, but limited to: involved in hiring and… more
- Sevita (Malden, MA)
- …as requested + Organize and chair program participant conferences + Review the designated program participant's reports (evaluation, progress, and discharge) for ... including clinical team meetings and regularly scheduled supervision meetings + Review monthly bills for designated program participants after receipt from… more
- Beth Israel Lahey Health (Burlington, MA)
- …Section (Chemistry or Specimen Processing). This includes training, procedure review , personnel hiring, evaluation and disciplinary actions, staff development and ... colleagues. 7. Work with section managers to ensure optimal utilization of staff and facilitate cross training of staff....schedule to include past performance and new goals. Fiscal Management 1. Prepare a budget annually with the Department… more
- The Home for Little Wanderers (Roslindale, MA)
- …reports) and billing in a timely manner. Ensure that documentation meets utilization review and quality assurance standards. + Attend in-service trainings ... neuropsychological, intellectual and emotional development, presence of learning disabilities, behavioral problems and need for psychopharmalogical intervention. Interpret results… more
- Takeda Pharmaceuticals (Boston, MA)
- …the DMPK strategy to progress drug discovery programs. + Ensures selection and utilization of appropriate in vitro, in vivo and/or in silico methods and models ... of potential drug candidates for in-licensing + Contributes to the preparation/editing/ review of documents for regulatory submission (ie, study reports, IB's, IND's)… more