- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …necessity criteria, interrater reliability test + Familiarity with our utilization management system, MedHOK What You Bring: + Behavioral Health professional ... your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care...experience in Behavioral Health Care settings + Utilization Management experience preferred + CCM or… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …us transform healthcare? Bring your true colors to blue. The RoleThe MSK Clinical Utilization Reviewer - LPN is responsible for reviews of commercial members ... work collaboratively with the MSK team and entire Clinical Utilization management team to facilitate orthopedic care...work: 8:30a - 4:30p EST. The TeamThe MSK Clinical Utilization Reviewer - LPN is part of… 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
- 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 ... in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital...of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience… more
- Evolent (Boston, MA)
- …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
- Evolent (Boston, MA)
- …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, Intake … 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 ... and educate to improve outcomes. -Assists with preparation and presentation of utilization review monitoring/trending reports for review with physicians… more
- Highmark Health (Boston, MA)
- …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
- Conviva (Boston, MA)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... other board demonstrating advanced training in transitions of care, quality assurance, utilization management and care coordination. + A current and unrestricted… more
- Elevance Health (Woburn, MA)
- …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 (Boston, MA)
- …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
- 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 ... registry health data for identified patient populations Monitors patient progress by utilization of disease specific registries to proactively reach out to patients… 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 ... 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
- Beth Israel Lahey Health (Burlington, MA)
- …manager. . Assists Utilization Managers with all aspects of utilization review /discharge planning/performance improvement processes. . Functions as liaison ... Rightfax, NaviHealth, Change Healthcare, Epic, etc. . Manages all utilization management work queues by researching and.... Complies with all Lahey Clinic Policies. Complies with behavioral expectations of the department and Lahey Clinic. .… more
- OptiMindHealth (Newton, MA)
- …FLSA Status: Non-Exempt Location: Newton, 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
- 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, ... correct or release data into the ERP system upon verification, review payment forecasts, offset credit balances against applicable debits, review payment… 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. ... certain medical criteria. This program is part of the Massachusetts Children's Behavioral Health Initiative (CBHI). Our two CSA programs together serve Dorchester,… 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 ... are seeking a Clinical Director to work at Walden Behavioral Care located in Waltham, MA. The **Clinical Director**...Equity and Inclusion practices + Employee selection and performance management experience are a plus. + Must hold a… 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 ... a difference in people's lives.** Clinical Supervisor (LICSW / LMHC) - Community Behavioral Health Center located in Lawrence, MA. **Job Description:** + **Sign on… more
- Elevance Health (Woburn, MA)
- …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