- Baylor Scott & White Health (Boston, MA)
- …Note: Benefits may vary based on position type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff. You oversee ... members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management, utilization review and different care levels. + Outstanding… more
- Beth Israel Lahey Health (Cambridge, MA)
- …200-bed acute care teaching hospital affiliated with Harvard Medical School. The Inpatient Case Manager (CM) performs utilization reviews and coordinates ... discharge planning for MAH inpatient admissions. Inpatient Case Manager performance is evaluated using the Inpatient Case Manager Guidelines and audit… more
- Brockton Hospital (Brockton, MA)
- …accepted criteria and guidelines to conduct review of inpatient admissions. The Case Manager at Brockton Hospital serves as the primary liaison between ... of five years clinical experience in an acute care facility required. Prior experience in case management, utilization review or discharge planning required. more
- State of Massachusetts (Brockton, MA)
- …Health's Brockton Multi Service Center (BMSC) is seeking an experienced Adult Case Manager to provide assessment, outreach, support, service coordination and ... Social Services* **Organization:** **Department of Mental Health* **Title:** *Adult Case Manager * **Location:** *Massachusetts-Brockton-165 Quincy Street* **Requisition… more
- Erickson Living (Hingham, MA)
- …of medical practice; insurance benefit structures and related legal/medical issues; and utilization review and quality assurance procedures. Please note that ... risk stratification, high-risk members will be identified, and a case opened for members who meet the criteria for...goals, and outcomes. + The Care Coordinator will measure case performance based on program goals, objectives, quality indicators,… more
- Sunrun (Boston, MA)
- …in through our commitment to diversity, inclusion and belonging. **Overview** The O&M Case Manager is responsible for coordinating effective execution of field ... and develop partner or branch relationships including weekly/monthly reviews, utilization and workload management, process updates and identification and resolution… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The Clinical Care Manager is responsible for facilitating care for members and families of members who ... Mobile, and Resident personas. The Team The Clinical Care Manager is part of a highly dedicated and motivated...to promote optimal member outcomes. + Interpret and apply case management criteria, processes, policies, and regulatory standards to… more
- Beth Israel Lahey Health (Beverly, MA)
- …care givers, and families. Their functions include concurrent and retrospective review to assure appropriate utilization , assessment, prevention of denials ... team, you're not just taking a job, you're making a difference in people's lives.** **Job Description:** Case managers serve as the care coordinators for patients,… more
- United Therapeutics (Boston, MA)
- …to meet the needs of the intended audience and contributors + End-to-end case processing, including data entry, QC, medical review , and regulatory submissions ... with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was… more
- State of Massachusetts (Brockton, MA)
- …* Conduct utilization management reviews as well as audit and approve monthly case management billing. * Review case management documentation for quality ... (ISPs), incident reports, screenings, referrals, discharge/transition plans, and clinical review summaries. * Assigns and reviews case ... case supervision and consultation to each assigned case manager and maintains documentation of the… more
- Sevita (Lawrence, MA)
- …receipt from accounting staff; identify any discrepancies to accounting staff + Coordinate utilization with the Case Manager relative to program ... to provide individual assistance to each person we serve. **Program Services Case Coordinator- Adult Day Health** Location: Oasis Adult Day Health Center Address:… more
- Beth Israel Lahey Health (Wakefield, MA)
- …engagement in healthy behavior. Working with the healthcare team, the Care Manager , RN monitors appropriate utilization of healthcare resources, promotes quality ... disability. The Care Manager , RN upholds the current standards of professional case management practice, and reports to the Manager of Care Management. **Job… more
- Highmark Health (Boston, MA)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to assure appropriate resource utilization , identification of opportunities for referral to a Health Coach/ case management, and… more
- Highmark Health (Boston, MA)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/ case management, and… more
- Deloitte (Boston, MA)
- …the C-Suite. Our services extend beyond HR to include the CEO, CFO, Risk Manager , and Business Unit leaders, delivering value and creating impact for our clients. ... client expectations and working with leading global businesses? Your RoleAs a Manager in Employer Health, you will provide strategic and technical employee benefit… more
- Nelnet (Boston, MA)
- …in territory by reviewing client contracts, maintaining contract end dates, championing utilization , and proactively engaging clients to extend/ review the term ... for people where they live, learn and work. The Manager - Account Executives - Sales - NCC -...one time per year to deliver an annual account review communicating Nelnet's value and long-range planning objectives. 9.… more
- Lawrence General Hospital (Lawrence, MA)
- …acute care setting with discharge planning, continuing care, care management, and utilization review preferred. + Strong verbal and written communications skills ... The RN Care Manager collaborates with physicians, nurses, and other clinical staff/directors to coordinate, facilitate and expedite patient care services across the… more
- Nestle (Sudbury, MA)
- …+ Risk Assessment and Elimination - Leads the effective implementation and utilization of risk assessment and risk prediction processes across sites to ensure ... recurrence are effectively implemented while also ensuring an effective injury case management process is fully implemented, well understood, and functioning as… more
- Beth Israel Lahey Health (Beverly, MA)
- …Improvement and CQI issues as well as to unsafe working conditions. Notifies manager of concerns. Participates in unit based QI activities and is familiar with ... appointment were followed and results are available for physician review Confirms that lab and other ancillary tests are...Serves as a liaison with patients, families to physicians, case managers, 3rd party payers, et al. Reviews, manages… 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 ... clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.… more