- Humana (Boston, MA)
- …hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management ... Director, depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care received by members in… more
- Brockton Hospital (Brockton, MA)
- …responsibilities include the development and supervision of staff (RNs, LPN's,SWs and non- clinical support), evaluation and maintenance of case management skills ... development and supervision of staff (RNs, LPN's, SWs and non- clinical support), evaluation and maintenance of case management...on the development and monitoring of the Care Maps project . Acts as liaison with payors and external review… more
- Parexel (Boston, MA)
- …before internal or external distribution. This includes both copyediting and content review. **Document Project Management ** + Act in the capacity of project ... serving as the primary client contact, negotiating deliverable timelines, and resolving project -related issues. Project management of contractual and… more
- Highmark Health (Boston, MA)
- …Analytical Skills + Advanced Problem-Solving + Advanced Communication Skills + Project Management + Customer Service + Leadership **EDUCATION** **Required** ... This role supports the full application product lifecycle for ** clinical and utilization management software** , with...The Open Framework Group (TOGAF) + Six Sigma + Project Management Professional (PMP) **Language (Other than… more
- Humana (Boston, MA)
- …communication of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise from inpatient or ... hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …with 3 years of clinical experience + Bachelor's degree in clinical discipline required, 2 years of utilization management experience required; health ... to blue. The Role:The Compliance Program Consultant will focus on utilization management compliance and audit readiness activities such as evaluating and supporting… more
- Humana (Boston, MA)
- …hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials,… more
- CenterWell (Boston, MA)
- …Revenue Cycle Professional (CRCP) * Lean Six Sigma (Green Belt or higher) * Project Management Professional (PMP) * Nursing license (RN or LPN/LVN) preferred but ... revenue integrity and patient access. The Director partners closely with clinical leadership, operations, finance, compliance, and IT, and manages both onshore… more
- Fujifilm (Boston, MA)
- …development and provide valuable feedback on products and market (ie coordinate clinical labs and office/conference evaluations for new products with KOL and global ... marketing teams). + Play a central role to provide clinical , technical, and market knowledge in the product franchise(s): which includes, but is not limited to… more
- Humana (Boston, MA)
- …and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, ... reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services.… more