- 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
- Evolent Health (Boston, MA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Intake … more
- Molina Healthcare (Waltham, MA)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high...years in one or more of the following areas: utilization management , case management , care… 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
- 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 (Salem, MA)
- …FLSA Status: Non-Exempt Location: Salem, 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 2016, we have… 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
- Beth Israel Lahey Health (Lawrence, MA)
- …the overall administration of the Urgent Care/Mobile Crisis Program, including the appropriate utilization and management of staff and quality of patient care ... a difference in people's lives.** Clinical Supervisor (LICSW / LMHC) - Community Behavioral Health Center located in Lawrence, MA. **Job Description:** + **Sign on… 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
- 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 (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
- 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
- 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
- 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
- Cambridge Health Alliance (Cambridge, MA)
- …operations functions (for multiple teams) including training, PACE team development, utilization review , quality improvement, and compliance. In addition, they ... Days:** 8am - 4:30pm M-F, rotating on-call weeks **Category:** Professional and Management **Department:** CHA PACE **Job Type:** Full time **Work Shift:** Day… more
- Fallon Health (Lowell, MA)
- …oriented, person-centered care, disease progression, disease prevention, wellness and management of chronic and episodic illness consistent with the participant's ... to Summit ElderCare program participants focusing on disease prevention, wellness and management of chronic and episodic illness. Addresses advance directives in a… 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