- Lawrence General Hospital (Lawrence, MA)
- The Utilization Review Specialist , under supervision and in collaboration with the Utilization Review Coordinator, Utilization Review Nurses, ... well as the integrated care team and supports the case management/ utilization review team on system-wide quality improvement/performance improvement initiatives.… more
- Tufts Medicine (Lowell, MA)
- …resolve accounts, including Patient Access, Revenue Integrity, Coding, Medical Records, Utilization Review , Hospital Departments, Physician's Offices, and other ... the delivery of support services or activities, typically under supervision. A specialist level role that requires very advanced knowledge of operational procedures… more
- Lawrence General Hospital (Lawrence, MA)
- … Works collaboratively with the Complex Care Nurse Managers, Social Workers, and Utilization Review Nurses, in coordinating and providing care that is safe, ... timely, effective, efficient, equitable and client-centered. Assuming all administrative responsibilities within the admission and discharge planning, Perform other duties as needed and assigned by your supervisor. JOB RESPONSIBILITIES: + Perform the full… more
- Highmark Health (Concord, NH)
- …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
- Verint Systems, Inc. (Concord, NH)
- …enrollment processes, including obtaining and analyzing benchmark data and utilization data, identifying trends, preparing recommendations with impact assessments ... across plans to address issues, discuss trends & best practice, utilization and opportunities for improvement. + Responsible for ensuring internal compliance… more
- Ensono (Concord, NH)
- …complexity assignments - owner (1 or >) Low complexity assignments - provide oversight/ review Regularly lead self and others and/or established as Product SME and/or ... established as specialist Understands how whole picture aligns to overall Ensono...and unscheduled Database refreshes Improve processes and procedures Log-file review Complex trouble-shooting and repairs Reporting on state of… more