- 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) ... your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care...management system, MedHOK What You Bring : + Behavioral Health professional with an active independent Massachusetts license:… 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 ... our Hingham, MA office. Hours of work: 8:30a - 4:30p EST. The TeamThe Clinical Utilization Reviewer is part of a highly dedicated and motivated team of… more
- Evolent (Providence, RI)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Highmark Health (Providence, RI)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… 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 ... management billing. * Review case ...staff have direct communication with Mobile Crisis Intervention (MCI), Behavioral Health Helpline &/or 911 as well as complete… more
- Sevita (Plymouth, MA)
- …with Autism Spectrum Disorders and other related disorders. **Regional Director Operations Management ** Have you been looking for a fantastic role to continue your ... quality. + Execute regional core growth strategy to increase census, maximize utilization and occupancy percentages; respond to local requests for proposals to… more
- Elevance Health (Smithfield, RI)
- …or regulation, must be in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... will be responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and...+ Background in Internal Medicine is strongly preferred. + Utilization management experience is a PLUS. Please… more
- Highmark Health (Providence, RI)
- …Description :** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent ... a prior authorization case 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 (Providence, RI)
- …:** **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
- OptiMindHealth (Boston, MA)
- …FLSA Status: Non-Exempt Location: Boston, 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
- Prime Healthcare (Woonsocket, RI)
- …facility is unable to meet the patient's care needs. The ICM is responsible for the utilization review process as it relates to triage and admission to the ... for the quality of emergency triage and appropriate resource management for all patients who present for emergent psychiatric...Behavioral Health Unit. The ICM is a patient advocate,… more
- Elevance Health (Smithfield, RI)
- …preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For ... necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts peer-to-peer… more
- Highmark Health (Providence, RI)
- …methods and tools and ensures that they are applied effectively. + Review others' system design to ensure selection of appropriate technology, efficient use ... in business terms and values. + Manage expectations of customers and management . + Represent various architectural disciplines in customer reviews and planning,… more
- State of Massachusetts (Brockton, MA)
- …necessary services are provided in the least restrictive environment. * Participate in utilization management reviews to monitor efficient use of resources. * ... not limited to, housing search, employment search, skill development, symptom management , wellness management , and encourages active participation in treatment… more
- Highmark Health (Providence, RI)
- …to deliver financial results to the Enterprise. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the… more
- Highmark Health (Providence, RI)
- …cases, which may involve speaking with providers via phone.At times, build cases in Utilization Review system during high volume times. + Other duties as ... contribute to highest levels of performance. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities including, but limited to: involved in hiring and… more
- Sharecare (Providence, RI)
- …other members of the health care team to support appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is supervised by...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- The Home for Little Wanderers (Roslindale, MA)
- …reports) and billing in a timely manner. Ensure that documentation meets utilization review and quality assurance standards. + Attend in-service trainings ... neuropsychological, intellectual and emotional development, presence of learning disabilities, behavioral problems and need for psychopharmalogical intervention. Interpret results… more
- The Home for Little Wanderers (Plymouth, MA)
- …documentation and assessments in a timely manner. Ensure that documentation meets utilization review and quality assurance standards. + Attend in-service ... grades 3 to 6 who have educational, emotional, and behavioral challenges that cannot be adequately addressed in a...program and in the family's home. + Provide case management services; act as a liaison with collateral agencies;… more