- Humana (Boston, MA)
- **Become 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 2 work… 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 knowledge ... communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for members who may ... our Hingham, MA office. Hours of work: 8:30a - 4:30p EDT. The TeamThe Clinical Utilization Reviewer is part of a highly dedicated and motivated team of… more
- Beth Israel Lahey Health (Burlington, MA)
- …the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg ... in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient...of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience… more
- CenterWell (Boston, MA)
- …education spanning onboarding to continuing education. **Role Description** The LCSW Behavioral Health Educator will be embedded within the clinical education team ... and will oversee training aspects of the cognitive behavioral health screenings, psychosocial assessments, techniques that can be...has a deep understanding of all the High-risk program management roles and gains the respect and confidence of… more
- Tufts Medicine (Malden, MA)
- …Tufts Medicine's overall behavioral health strategy. + Oversee clinical resource management , utilization review , and medical staff operations to optimize ... evaluation, and prescribe medications and treatments. + Assist in the management of behavioral or mental health problems of patients and maintain current… more
- Humana (Boston, MA)
- …. At least five years of experience post-training providing clinical services . Experience in utilization management review and case management in a ... caring community and help us put health first** The Behavioral Health Medical Director responsible for behavioral ...work in their assigned cluster + Work includes computer-based review of moderately complex to complex clinical scenarios, … more
- Tufts Medicine (Lowell, MA)
- …Department daily; including census/admission/discharge-based assignments. 2. Ensures the EPIC Care Management & Behavioral Health work queues are up-to-date ... as needed to maintain seamless operations. 10. Runs regularly scheduled reports for management to review and analyze team performance, referral volume, and… 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)
- …Formularies, utilization management programs, and case/ disease management initiatives; providing clinical review and decisions for physician and ... utilization management programs, and disease management initiatives. + Provide clinical review and...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …care). + Experience as a working leader and managing member cases. + 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
- Commonwealth Care Alliance (Boston, MA)
- …Community Health Workers (CHWs) are key supports to interdisciplinary care management teams and complement and support enrollees' needs, goals, and preferences. ... coaching skills to improve CCA enrollee outcomes by impacting care access and utilization , closing care quality gaps, and optimizing member connection to medical, … more
- Beth Israel Lahey Health (Woburn, MA)
- …plans since last appointment were followed and results are available for physician review o Confirms that lab and other ancillary tests are performed and results ... health data for identified patient populations o Monitors patient progress by utilization of disease specific registries to proactively reach out to patients to… more
- Highmark Health (Boston, MA)
- …**Job Description :** **JOB SUMMARY** This job captures all inbound inquires for utilization management review from providers and pharmacies. The incumbent ... the case (data entry) 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
- Beth Israel Lahey Health (Beverly, MA)
- …plans since last appointment were followed and results are available for physician review Confirms that lab and other ancillary tests are performed and results ... registry health data for identified patient populations Monitors patient progress by utilization of disease specific registries to proactively reach out to patients… more
- OptiMindHealth (Medford, MA)
- …FLSA Status: Non-Exempt Location: Medford, 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
- State of Massachusetts (Tewksbury, MA)
- …Service program design based on assessment of client and community needs and utilization management processes, incorporating state of the art best practices in ... will also involve making critical decisions in care transitions, clinical risk management , and collaboration with hospitals and behavioral health centers, all… more
- Monte Nido (Dedham, MA)
- …regulatory agencies. + Conduct psychosocial assessments, participate in treatment planning, utilization review , and discharge planning. + Conduct individual, ... people to realize their healthy selves. **Adolescent Clinician** **Walden Behavioral Care** **Dedham- FT position** Walden Behavioral ...and ARFID cases. + Provide clinical care and case management in a manner consistent with the philosophy and… more