- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- Humana (Providence, RI)
- …such as provider relations, claims submission and payment, utilization management processes, behavioral health processes, and dispute resolution. ... part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Senior...educational material, or trainings. + 3+ years of project management experience with mid-size projects. + 2+ years of… more
- Beth Israel Lahey Health (Burlington, MA)
- …of three years of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated ... team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg experience… more
- Beth Israel Lahey Health (Burlington, MA)
- …difference in people's lives.** This position is on-site. **Job Description:** The Utilization Analyst works with physicians, the payers and inpatient case ... management team to validate the medical necessity of the...necessity of the hospital care. Using the concepts of utilization review, clinical documentation improvement and revenue integrity, these… more
- Highmark Health (Providence, RI)
- …Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care services, ... utilization , identification of opportunities for referral to a Health Coach/case management , and identification and resolution...years of post licensure experience in a combination of Behavioral Health Clinical, Case Management … more
- Dartmouth Health (Keene, NH)
- Functioning as a member or the Behavioral Health Team, the Master's Level Clinician, in collaboration with physicians and multidisciplinary team members, this ... physician practice, while emphasizing care coordination across the continuum. Perform utilization management activities as necessary to ensure that medical… more
- Hartford HealthCare (Mansfield Center, CT)
- …We offers a variety of programs including inpatient and outpatient behavioral health , residential treatment for court-involved teenage girls, geriatric ... facility on the Mansfield campus for adolescent girls with identified needs for behavioral health services who admitted through a referral from the juvenile… more
- Hartford HealthCare (Dayville, CT)
- …We offers a variety of programs including inpatient and outpatient behavioral health , residential treatment for court-involved teenage girls, geriatric ... by offering programs throughout Eastern Connecticut. _**_ _*Job Summary*_ Lead Behavioral Health Clinician works in coordination with interdisciplinary teams… more
- Beth Israel Lahey Health (Woburn, MA)
- …with all Lahey Health policies and clinical protocols. * Complies with behavioral expectations of the department and Lahey Health . * Demonstrates an ... The Medical Assistant works in collaboration with the physician(s), other health care provider(s), and other ambulatory support staff within the department… more
- Highmark Health (Providence, RI)
- …in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care services, ... utilization , identification of opportunities for referral to a Health Coach/case management , and identification and resolution...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Harvard University (Cambridge, MA)
- …members of the Harvard community. Our work includes multi-specialty ambulatory medical care, behavioral and mental health services, and campus public health . ... 66674BRAuto req ID:66674BRJob Code:403049 Health Assistant II Department Office Location:USA - MA...AGE SPECIFIC COMPETENCIES: Provides care to the adolescent through utilization of the following: a. Supplements explanations with reasons… more
- Elevance Health (Smithfield, RI)
- …The **Medical Director** will be responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most ... For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years...+ Background in Internal Medicine is strongly preferred. + Utilization management experience is a PLUS. Please… more
- Beth Israel Lahey Health (Burlington, MA)
- …including Interqual, Rightfax, NaviHealth, Change Healthcare, Epic, etc. . Manages all utilization management work queues by researching and following up on ... appropriate coverage and escalates issues to the manager. . Assists Utilization Managers with all aspects of utilization review/discharge planning/performance… more
- Elevance Health (Woburn, MA)
- …for over 150 years. With capabilities spanning pharmacy, behavioral health , complex care delivery, medical benefits management , payment integrity, palliative ... risk solution spans 100% of the total cost of care for our patients, integrating utilization management , care management , pharmacy management , and data… more
- Elevance Health (Smithfield, RI)
- …A proud member of the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health Options, offers superior clinical mental ... preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For… 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 ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- Fenway Health (Boston, MA)
- …consistent with the care philosophy of patient-centeredness, non-judgmental, harm reduction, behavioral health integration, and team-based care. The nurse serves ... Job Type Part-time Description As a Registered Nurse (RN) at Fenway Health you will provide compassionate, evidence-based, and efficient care to individuals,… more
- Sevita (Springfield, MA)
- **Mentor South Bay** , provides Early Intervention, Applied Behavioral Analysis (ABA), Behavioral Health and Mental Health Outpatient services across ... Implement program core growth strategy to maintain or increase census, maximize utilization and occupancy percentages, and assist with new start development. +… more
- Highmark Health (Providence, RI)
- …, physician practice management or clinical operations, ancillary provider management or clinical operations, and/or health insurance) with significant ... knowledge of and experience with various care delivery models + Experience in health plan provider network performance management , care/case management ,… more
- Beth Israel Lahey Health (Burlington, MA)
- …Activities:** 1. Participate in the development and support of formulary management and medication utilization initiatives that promote the cost-effective ... health care professionals about the drug therapy prescribing, management and monitoring 5. Provide support for the LCPN...* Comply with all Lahey Policies. * Comply with behavioral expectations of the LCPN Division. * Maintain courteous… more