- State of Massachusetts (Boston, MA)
- …as needed to ensure compliance with program rules and regulations. . Conducts review of client files, incident reports, utilization and other program ... Office of Housing and Livable Communities (EOHLC_*_)__i*s seeking a HomeBASE Specialist Floater in the Division of Housing Stabilization!*_ *_AGENCY MISSION:_* The… more
- State of Massachusetts (Tewksbury, MA)
- …an experienced and dynamic professional for the position of Office Support Specialist I to provide administrative support the Central Nursing Office (CNO) ... the HR/CMS payroll system in a timely manner. . Review printouts of time submission for discussion with employees...issues. . Assists the Hiring Coordinator and Office Support Specialist with the processing of all clerical interviews and… more
- Tufts Medicine (Burlington, MA)
- …(ICU, ED, Critical Care, strong Med/Surg Specialty) or equivalent case management, utilization review , denials management, or progressive leadership in an ... Specialist III is responsible for concurrent and retrospect review and analysis of the medical record to improve...indicators where indicated. 10. Collaborates with case management and utilization review team to ensure that documentation… more
- Cambridge Health Alliance (Cambridge, MA)
- …team leader in multi-disciplinary team discussion regarding treatment planning, treatment review , quality assurance and utilization review ... Nurse Practitioner - Clinical Specialist II (APRN), Psychiatry Apply (https://careers.chaproviders.org/clinical- specialist -2-psychiatry) Refer a Friend Back… more
- Beth Israel Lahey Health (Burlington, MA)
- …in people's lives.** **Job Description:** **Position Summary:** The Clinical Pharmacy Specialist - Population Health works collaboratively with other health care ... patients, and guideline development and implementation. Additionally, the Clinical Pharmacy Specialist supports the safe, effective and efficient use of medication… more
- Suffolk University (Boston, MA)
- Academic Content & Technology Specialist Staff Exempt Boston, Massachusetts Apply Description Provide administrative and technical support for College of Arts & ... paperwork from start to finish through faculty governance process, including initial review of all submitted paperwork for accuracy and compliance with requirements… more
- Motion Recruitment Partners (Boston, MA)
- …service delivery. * Data Analysis and Reporting: o Prepare regular reports on benefits utilization , costs, and trends for management review . o Assist in the ... Sr. Principal Human Resources Specialist Boston, MA **Remote Local** Contract **Title:** Sr. Principal Human Resources Specialist **Description:** Key… more
- Beth Israel Lahey Health (Charlestown, MA)
- …include, utilization of our ERP system to: process/enter invoices/credits, review and resolve invoice coding and statement issues, monitor and respond to ... emails received in the general departmental mailbox (apx 500-700/daily), review /obtain approvals and release vouchers on payment hold, interact with Purchasing and… more
- Tufts Medicine (Burlington, MA)
- …setting (ICU, ED, Critical Care, strong Med/Surg Specialty) OR case management, utilization review , or denials management in an acute-care hospital setting ... job area. **Job Overview** The position is responsible for review and analysis of the medical record to improve...and responsibilities may be assigned. 1. Performs initial concurrent review of new patients every day and concurrent re-reviews… more
- World Insurance Associates, LLC. (Wakefield, MA)
- …strategy meetings with client advisors and account executives + Promote utilization of strategic Trading Partners critical to maintaining secure and dependable ... commercial insurance program designs to the Client Advisor and/or Account Executive after review with senior staff + Assist with the preparation of submissions and… more
- Highmark Health (Boston, MA)
- …Inc. **Job Description :** **JOB SUMMARY** 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,… more
- State of Massachusetts (Boston, MA)
- …promoting coordination on various mental health topics and navigating systems. * Support utilization review processes: Support utilization review ... the direct supervision of the Regional Clinical Mental Health Specialist Manager, while also being overseen by the Director...to mental and behavioral health challenges. * Develop and review clinical plans: Create and review clinical… more
- Verint Systems, Inc. (Boston, MA)
- …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
- Commonwealth Care Alliance (Boston, MA)
- …coaching skills to improve CCA enrollee outcomes by impacting care access and utilization , closing of care quality gaps, and optimizing member connection to medical, ... an integral role in reducing high ED and inpatient utilization related to unmet social needs, including housing, food,...manner; promote and enforce the CCA compliance program + Review the Code of Conduct at least annually and… more
- ThermoFisher Scientific (Cambridge, MA)
- …monitoring environments (ie FSO, FSP, Government, etc.). Acts as a site processes specialist , ensuring that the trial is conducted in accordance with the approved ... risks. Ensures data accuracy through SDR, SDV and CRF review as applicable through on-site and remote monitoring activities....personnel + Ability to maintain customer focus through the utilization of good listening skills, attention to detail and… more
- Commonwealth Care Alliance (Boston, MA)
- …claims adjudication, clinical coding reviews for claims, settlement, claims auditing and/or utilization review required + Proven ability to apply quantitative ... editing systems (CES and Zelis).The Policy Manager will also review current payment policies and compare them to those...completion of change + Serve as the company's research specialist regarding Medicare and Medicaid payment policies + Serves… more
- Dana-Farber Cancer Institute (Boston, MA)
- …procedures facilities, off-site medical facilities, oral medicine and other consulting specialist offices, hospital admitting, and a host of other resources involved ... the assigned patient population to achieve patient safety, flow and the resource utilization goals of the organization + Responsible for ensuring filing or reporting… more
- South Middlesex Opportunity Council (Framingham, MA)
- …Director, responsible for the design, development, implementation and ongoing maintenance of Utilization Review process for all clinical services. + Engage all ... + Monitor caseloads and work with the clinic intake specialist to triage and assign cases from a waitlist....and state agencies as well as community organizations. + Review and develop policies and procedures that reflect regulations,… more
- Beth Israel Lahey Health (Peabody, MA)
- …forms per procedure and department protocol + Follows up with patient or specialist to ensure patient care plans since last appointment were followed and results ... are available for physician review + Confirms that lab and other ancillary tests...for identified patient populations + Monitors patient progress by utilization of disease specific registries to proactively reach out… more
- Beth Israel Lahey Health (Peabody, MA)
- …required forms per procedure and department protocol. Follows up with patient or specialist to ensure patient care plans since last appointment were followed and ... results are available for physician review . o Confirms that lab and other ancillary tests...for identified patient populations. o Monitors patient progress by utilization of disease specific registries to proactively reach out… more