• Utilization Management

    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 ... more
    Humana (01/16/25)
    - Save Job - Related Jobs - Block Source
  • Utilization Management

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …years of clinical experience in Behavioral Health Care settings + Utilization Management experience preferred + CCM or other applicable certification(s) ... more
    Blue Cross Blue Shield of Massachusetts (01/03/25)
    - Save Job - Related Jobs - Block Source
  • Utilization Management

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for our Medicare ... more
    Blue Cross Blue Shield of Massachusetts (12/19/24)
    - Save Job - Related Jobs - Block Source
  • Case Manager with Utilization Review

    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 ... more
    Beth Israel Lahey Health (01/15/25)
    - Save Job - Related Jobs - Block Source
  • Utilization Analyst Case Management

    Beth Israel Lahey Health (Burlington, MA)
    …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... more
    Beth Israel Lahey Health (01/15/25)
    - Save Job - Related Jobs - Block Source
  • Care Manager Behavioral Health - Part Time…

    Highmark Health (Boston, MA)
    …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... more
    Highmark Health (12/12/24)
    - Save Job - Related Jobs - Block Source
  • PA Office Support Representative

    Highmark Health (Boston, MA)
    …OVERVIEW: * Receive, review and make determinations regarding physician reviewer assignments for medical management decisions. Cases requiring physician ... more
    Highmark Health (01/16/25)
    - Save Job - Related Jobs - Block Source
  • Adult Case Management Supervisor

    State of Massachusetts (Brockton, MA)
    …(HSC Is) to ensure compliance with DMH Regulations, policies, and procedures. * Conduct utilization management reviews as well as audit and approve monthly case ... more
    State of Massachusetts (12/24/24)
    - Save Job - Related Jobs - Block Source
  • Medical Assistant at Winchester Weight…

    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 ... more
    Beth Israel Lahey Health (12/29/24)
    - Save Job - Related Jobs - Block Source
  • Care Manager RN - Weekends (Remote)

    Highmark Health (Boston, MA)
    …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... more
    Highmark Health (01/07/25)
    - Save Job - Related Jobs - Block Source
  • Medical Assistant I

    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 ... more
    Beth Israel Lahey Health (12/10/24)
    - Save Job - Related Jobs - Block Source
  • Part-Time Weekend Medical Director (Remote)

    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 ... more
    Highmark Health (12/13/24)
    - Save Job - Related Jobs - Block Source
  • Operation Specialist

    Beth Israel Lahey Health (Burlington, MA)
    …manager. . Assists Utilization Managers with all aspects of utilization review /discharge planning/performance improvement processes. . Functions as liaison ... more
    Beth Israel Lahey Health (12/10/24)
    - Save Job - Related Jobs - Block Source
  • Physician Liaison / Outreach Coordinator

    OptiMindHealth (Revere, MA)
    …FLSA Status: Non-Exempt Location: Revere, MA Join a leading clinician-led behavioral health company today! OptiMindHealth (OMH) is expanding and seeking ... more
    OptiMindHealth (11/07/24)
    - Save Job - Related Jobs - Block Source
  • Accounts Payable Control Specialist II

    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, ... more
    Beth Israel Lahey Health (12/10/24)
    - Save Job - Related Jobs - Block Source
  • Mental Health Intensive Care Coordinator…

    The Home for Little Wanderers (Dorchester, MA)
    …documentation and billing in a timely manner. Ensure that documentation meets utilization review and quality assurance standards. + Attend staff meetings. ... more
    The Home for Little Wanderers (10/25/24)
    - Save Job - Related Jobs - Block Source
  • Clinical Analyst Appeals

    Beth Israel Lahey Health (Charlestown, MA)
    …and familiarity with CPT/HCPCs/DRG coding experience required. . Clinical education and/or utilization review experience strongly preferred. . Requires minimum 2 ... more
    Beth Israel Lahey Health (01/16/25)
    - Save Job - Related Jobs - Block Source
  • Clinical Director

    Monte Nido (Waltham, MA)
    …may substitute leadership experience elsewhere. + Working knowledge of admissions and intake, Utilization Review , and 3rd party or insurance payers. + Previous ... more
    Monte Nido (12/15/24)
    - Save Job - Related Jobs - Block Source
  • Clinical Supervisor (LICSW/LMHC) - Adult Urgent…

    Beth Israel Lahey Health (Lawrence, MA)
    …the overall administration of the Urgent Care/Mobile Crisis Program, including the appropriate utilization and management of staff and quality of patient care ... more
    Beth Israel Lahey Health (12/10/24)
    - Save Job - Related Jobs - Block Source
  • Associate Medical Director - Orthopedic Surgery

    Elevance Health (Woburn, MA)
    …preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For ... more
    Elevance Health (12/17/24)
    - Save Job - Related Jobs - Block Source