- 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
- Highmark Health (Boston, MA)
- …OVERVIEW: * Receive, review and make determinations regarding physician reviewer assignments for medical management decisions. Cases requiring physician ... agencies' standards including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Committee (URAC), Pennsylvania Department of… 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
- 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 (Quincy, MA)
- …FLSA Status: Non-Exempt Location: Quincy, 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
- Beth Israel Lahey Health (Charlestown, MA)
- …and familiarity with CPT/HCPCs/DRG coding experience required. . Clinical education and/or utilization review experience strongly preferred. . Requires minimum 2 ... aspects of clinical appeals, audits, and compliance issues to management . . Participates in complex projects related to denial...managers are involved. . Assist in the tracking and review of payer audit and denial results. Prepare appeal… 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
- Highmark Health (Boston, MA)
- …to deliver financial results to the Enterprise. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …health care settings (Inpatient, outpatient, or differing levels of care). + Utilization Management experience, preferred + Active licensure in Massachusetts is ... and regulatory standards to create, follow and appropriately document comprehensive care management plans. + Review medication list and educate members with… 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
- Harvard University (Cambridge, MA)
- …quality projects, daily huddles, Lean activities, and other continuing education, utilization management , and other departmental activities. + Fosters positive ... sponsorship. + This position has a 90-day orientation and review period. Department:Urgent CarePre-Employment Screening:Criminal, Education, IdentitySchedule: Schedule Week… more
- Sevita (Canton, MA)
- …as requested + Organize and chair program participant conferences + Review the designated program participant's reports (evaluation, progress, and discharge) for ... clinical team meetings and regularly scheduled supervision meetings + Coordinate utilization with the Case Manager relative to program participant's incentive… 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 in-service training ... part of this incredible new addition to the Massachusetts behavioral health landscape for youth and young adults! **How...path toward a better, brighter future. + Provide case management services; act as a liaison with collateral agencies… more
- The Home for Little Wanderers (Plymouth, MA)
- …documentation and assessments in a timely manner. Ensure that documentation meets utilization review and quality assurance standards. + Attend in-service ... grades 3 to 6 who have educational, emotional, and behavioral challenges that cannot be adequately addressed in a...program and in the family's home. + Provide case management services; act as a liaison with collateral agencies;… more