- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within… more
- Beth Israel Lahey Health (Burlington, MA)
- …of three years of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated ... team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg experience… more
- CenterWell (Boston, MA)
- …training education spanning onboarding to continuing education. **Role Description** The LCSW Behavioral Health Educator will be embedded within the clinical ... team and will oversee training aspects of the cognitive behavioral health screenings, psychosocial assessments, techniques that...has a deep understanding of all the High-risk program management roles and gains the respect and confidence of… more
- Beth Israel Lahey Health (Boston, MA)
- …clinic and professional standards of care. + assists with quality assurance and utilization management + maintains clinic and regulatory standards of care and ... and family members' ability to manage diabetes, and support to the clinic's educational/ behavioral /medical programs. _As a health care organization, we have the… more
- Humana (Boston, MA)
- …clinical services . Experience in utilization management review and case management in a health plan setting . No current sanction from Federal or ... part of our caring community and help us put health first** The Behavioral Health ...a focus on collaborative business relationships, value-based care, population health , or disease or care management +… more
- Highmark Health (Boston, MA)
- …account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and case/ disease management ... information to improve individual outcomes as an adjunct to health coaching. If acting in the capacity as a...review. + Assist in the development and implementation of utilization management programs including but not limited… more
- Commonwealth Care Alliance (Boston, MA)
- …utilization , closing care quality gaps, and optimizing member connection to medical, behavioral health , and substance use disorder resources. CHWs play an ... Team and Primary Care Provider (PCP) or specialty care providers (eg, behavioral health clinician). + CHWs utilize recovery-centered strategies, harm reduction… more
- Beth Israel Lahey Health (Woburn, MA)
- …with all Lahey Health policies and clinical protocols. * Complies with behavioral expectations of the department and Lahey Health . * Demonstrates an ... The Medical Assistant works in collaboration with the physician(s), other health care provider(s), and other ambulatory support staff within the department… more
- Highmark Health (Boston, MA)
- …Description :** **JOB SUMMARY** This job captures all inbound inquires for utilization management review from providers and pharmacies. The incumbent assesses ... and then creates the case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Elevance Health (Woburn, MA)
- …for over 150 years. With capabilities spanning pharmacy, behavioral health , complex care delivery, medical benefits management , payment integrity, palliative ... involved in Utilization Management , Specialty Benefits Management , Payment Integrity, Advocacy, Health Plan Subrogation, Behavioral Health , … 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 ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- Fenway Health (Boston, MA)
- …consistent with the care philosophy of patient-centeredness, non-judgmental, harm reduction, behavioral health integration, and team-based care. The nurse serves ... Job Type Part-time Description As a Registered Nurse (RN) at Fenway Health you will provide compassionate, evidence-based, and efficient care to individuals,… more
- Boston Health Care for the Homeless Program (Boston, MA)
- …the successful utilization of these resources. + Provide patients with health promotion, behavioral risk reduction, and prevention of communicable disease ... from preventative dental care to cancer treatment. Our clinicians, case managers, and behavioral health professionals work in more than 30 locations to serve… more
- Sevita (West Boylston, MA)
- …with Autism Spectrum Disorders and other related disorders. **Regional Director Operations Management ** Have you been looking for a fantastic role to continue your ... quality. + Execute regional core growth strategy to increase census, maximize utilization and occupancy percentages; respond to local requests for proposals to… more
- Highmark Health (Boston, MA)
- …(NCQA), Utilization Review Accreditation Committee (URAC), Pennsylvania Department of Health , Department of Labor, the Center for Medicare and Medicaid Services ... review and make determinations regarding physician reviewer assignments for medical management decisions. Cases requiring physician review are provider and member… more
- Cecelia Health (Boston, MA)
- …and customized analytics. The analytics support value-based care, population health management , quality outcomes, performance targets, and identification ... Who We Are: Cecelia Health is a national virtual specialty medical practice...whole person with proactive, coordinated support focused on clinical, behavioral , social, and emotional needs across cardiometabolic and related… more
- State of Massachusetts (Tewksbury, MA)
- …transitions, clinical risk management , and collaboration with hospitals and behavioral health centers, all while championing diversity, equity, and inclusion ... Service program design based on assessment of client and community needs and utilization management processes, incorporating state of the art best practices in… more
- Harvard University (Cambridge, MA)
- …members of the Harvard community. Our work includes multi-specialty ambulatory medical care, behavioral and mental health services, and campus public health . ... and their departments. Educates them to resources available at Harvard University Health Services. + Participates in/attends IM Team Meetings and daily huddles. +… more
- Highmark Health (Boston, MA)
- …sales revenue and expanding market share through new client acquisition and relationship management . The ideal candidate will have a strong background in B2B sales, ... as: Financial Services, Utilities, Property and Casualty Insurance + CRM utilization **Preferred** + Transactional print and mail and digital delivery experience… more