- 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
- 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 (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
- 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 (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... more
- 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 (Boston, MA)
- …OVERVIEW: * Receive, review and make determinations regarding physician reviewer assignments for medical management decisions. Cases requiring physician ... more
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Elevance Health (Woburn, MA)
- …preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For ... more