- 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
- Milford Regional Medical Center (Milford, MA)
- …with other members of the healthcare team, the Point of Entry/Emergency Department Case Manager (POE/ED CM) is accountable for coordination and facilitation of ... with knowledge of current medical care technology and ancillary supports. Previous utilization review experience preferred Must be assertive with excellent… 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
- 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
- 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
- South Middlesex Opportunity Council (Worcester, MA)
- …for all assigned properties as detailed below. Working closely with an assigned Case Manager to ensure that all property, municipal, regulatory and contractual ... focusing on maintenance, upkeep of the building, and general house issues. Involve the Case Manager (s) as needed. + Ensure operational readiness for all newly… 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
- Fallon Health (Worcester, MA)
- …Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The Social Work Care Manager (SWCM) works very closely with Fallon Health Care Team staff, Provider ... rounds and huddles o Works with members of the Utilization Management Department assisting with difficult or complex care...engage in Interdisciplinary team meetings o Works with Nurse Case Managers and Navigators to coordinate a continuum of… 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
- 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 (Burlington, 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
- Beth Israel Lahey Health (Burlington, MA)
- …. . Assists Utilization Managers with all aspects of utilization review /discharge planning/performance improvement processes. . Functions as liaison for ... including Interqual, Rightfax, NaviHealth, Change Healthcare, Epic, etc. . Manages all utilization management work queues by researching and following up on all… more
- Elevance Health (Woburn, MA)
- …the medical necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts ... + Extensive orthopedic surgery experience preferred. + Experience with utilization management, especially with CMS guidelines preferred. For candidates working… more
- Elevance Health (Woburn, MA)
- …must be located 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
- Fallon Health (Worcester, MA)
- …and corrective action planning must be established for each respective case and adjudication completed in accordance with existing regulations, policies, and ... Authorization Protocol, authorizations not meeting protocol parameters are prepared for review , including direct contact with physician's offices and physicians to… more
- Beth Israel Lahey Health (Burlington, 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...Serves as a liaison with patients, families to physicians, case managers, 3rd party payers, et al. + Reviews,… more
- Beth Israel Lahey Health (Burlington, 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 o Confirms that lab and other ancillary tests...Serves as a liaison with patients, families to physicians, case managers, 3rd party payers, et al. o Reviews,… more