- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical ... Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality...Case Manager experience as well as Utilization Review experience ( review medical… more
- Baystate Health (Springfield, MA)
- The Hospital Case Manager is a registered nurse responsible for the coordination of clinical care, quality, and financial outcomes of a designated population of ... patients. The Hospital Case Manager is responsible for overseeing an...+ Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by… more
- Prime Healthcare (Woonsocket, RI)
- …Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities The Intake Case Manager (ICM) has ... 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 Behavioral… more
- Milford Regional Medical Center (Milford, MA)
- …with other members of the healthcare team, the Point of Entry/Emergency Department Case Manager (POE/ED CM) is accountable for coordination and facilitation of ... with knowledge of current medical care technology and ancillary supports. Previous utilization review experience preferred Must be assertive with excellent… more
- Sunrun (Providence, RI)
- …in through our commitment to diversity, inclusion and belonging. **Overview** The O&M Case Manager is responsible for coordinating effective execution of field ... and develop partner or branch relationships including weekly/monthly reviews, utilization and workload management, process updates and identification and resolution… more
- United Therapeutics (Providence, RI)
- …to meet the needs of the intended audience and contributors + End-to-end case processing, including data entry, QC, medical review , and regulatory submissions ... with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was… more
- Highmark Health (Providence, RI)
- …Remote - Part Time - Weekends Required.** 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, and… more
- South Middlesex Opportunity Council (Worcester, MA)
- …for all assigned properties as detailed below. Working closely with an assigned Case Manager to ensure that all property, municipal, regulatory and contractual ... focusing on maintenance, upkeep of the building, and general house issues. Involve the Case Manager (s) as needed. + Ensure operational readiness for all newly… more
- Deloitte (Boston, MA)
- …the C-Suite. Our services extend beyond HR to include the CEO, CFO, Risk Manager , and Business Unit leaders, delivering value and creating impact for our clients. ... client expectations and working with leading global businesses? Your RoleAs a Manager in Employer Health, you will provide strategic and technical employee benefit… more
- Nelnet (Providence, RI)
- …in territory by reviewing client contracts, maintaining contract end dates, championing utilization , and proactively engaging clients to extend/ review the term ... for people where they live, learn and work. The Manager - Account Executives - Sales - NCC -...one time per year to deliver an annual account review communicating Nelnet's value and long-range planning objectives. 9.… more
- Nestle (Sudbury, MA)
- …+ Risk Assessment and Elimination - Leads the effective implementation and utilization of risk assessment and risk prediction processes across sites to ensure ... recurrence are effectively implemented while also ensuring an effective injury case management process is fully implemented, well understood, and functioning as… more
- Beth Israel Lahey Health (Burlington, MA)
- …Improvement and CQI issues as well as to unsafe working conditions. Notifies manager of concerns. Participates in unit based QI activities and is familiar with ... appointment were followed and results are available for physician review Confirms that lab and other ancillary tests are...Serves as a liaison with patients, families to physicians, case managers, 3rd party payers, et al. Reviews, manages… 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 ... clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.… more
- Beth Israel Lahey Health (Burlington, MA)
- …. . Assists Utilization Managers with all aspects of utilization review /discharge planning/performance improvement processes. . Functions as liaison for ... including Interqual, Rightfax, NaviHealth, Change Healthcare, Epic, etc. . Manages all utilization management work queues by researching and following up on all… more
- 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 ... of HomeBASE and Rapid Rehousing, the Affordable Housing and Subsidy Resource Manager and collaborates closely with the Regional Teams and Housing Search Specialists… more
- Elevance Health (Smithfield, RI)
- …the medical necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts ... + Extensive orthopedic surgery experience preferred. + Experience with utilization management, especially with CMS guidelines preferred. For candidates working… more
- Hartford HealthCare (Dayville, CT)
- …programming which may include staff scheduling, scheduling clinical activities, program development, utilization review , case load assignment, and attending ... assume clinical oversight of daily operations in the absence of Program Manager . Key responsibilities of Lead Behavioral Health Clinician: * Conducts a comprehensive… more
- Hartford HealthCare (Mansfield Center, CT)
- …programming which may include staff scheduling, scheduling clinical activities, program development, utilization review , case load assignment, and attending ... assume clinical oversight of daily operations in the absence of Program Manager . Key responsibilities of Lead Behavioral Health Clinician: * Conducts a comprehensive… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …+ **Minimum Experience:** + 1 year of clinical and/or related experience required. Case Management, Utilization Review and/or Prior Authorization experience ... overturned. + Appropriately escalates complex cases to Drug Authorization Supervisor or Manager of Prior Authorizations. + Monitors email communication to the Drug… more
- Beth Israel Lahey Health (Milton, MA)
- …least 5 years acute care hospital level nursing experience (eg, ER, ICU) or equivalent case management, quality, or utilization review in a hospital setting ... of mortality, and severity of illness; and (b) track review details in 3M software. 2. Conducts follow-up reviews...in the medical record. 5. Collaborates with the CDI Manager & Physician Advisor and other ancillary staff regarding… more