• Social Work Manager

    Fallon Health (Worcester, MA)
    …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Summary of purpose:** Functions ... clinical services to participants and families in the form of psychosocial assessment and treatment. * Provides on-going case management for participants as needs… more
    Fallon Health (06/06/25)
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  • Medical Director, MSK Surgery

    Evolent (Boston, MA)
    …as assigned mentor as needed for new hires and completes new hire case assessment working on any defined areas of opportunity. + Assists with Hot Topic ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
    Evolent (05/20/25)
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  • RN Case Manager

    Tufts Medicine (Lowell, MA)
    …Manager manages a designated caseload to coordinate and complete timely assessment , planning, implementation and evaluation of discharge plans and care transitions ... and cultural needs of those patients. + Maintains documentation of assessment findings, discharge arrangements, and actions taken according to departmental… more
    Tufts Medicine (08/16/25)
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  • RN Case Manager/ Sign on Bonus Eligible!

    Tufts Medicine (Melrose, MA)
    …Manager manages a designated caseload to coordinate and complete timely assessment , planning, implementation and evaluation of discharge plans and care transitions ... and cultural needs of those patients. 2. Maintains documentation of assessment findings, discharge arrangements, and actions taken according to departmental… more
    Tufts Medicine (08/10/25)
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  • Care Coordinator / Navigator - Cape Cod

    Fallon Health (Barnstable, MA)
    …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... may conduct face-to-face member visits to assess members utilizing TruCare Assessment Tools + Establishing and developing effective working relationships with… more
    Fallon Health (08/08/25)
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  • Senior Risk Partner - Compliance Officer

    Highmark Health (Boston, MA)
    …in-depth knowledge of HIPAA and possess the ability to perform a privacy risk assessment . The incumbent must have the highest level of integrity and ethics and ... monitoring and implementation of new or changing regulatory requirements, risk assessment and audit execution, risk treatment plans, policy and procedure… more
    Highmark Health (07/29/25)
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  • RN Clinical Manager

    CenterWell (Pittsfield, MA)
    …organizes clinical operations for a specific location managed. + Conducts/delegates the assessment and reassessment of patients, including updating of care plans and ... final audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers… more
    CenterWell (08/16/25)
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  • Social Worker ll- 55+ PACE Program-no nights…

    Fallon Health (Leominster, MA)
    …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Brief summary of purpose:** ... the intake and evaluation process by conducting the initial social work assessment , administering MSQs, developing an intake summary and presenting the social work… more
    Fallon Health (08/13/25)
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  • ED RN Case Manager - UR & Discharge Planning

    Beth Israel Lahey Health (Plymouth, MA)
    …InterQual criteria to assess for appropriate level of care assignment. Certifies Medicare admissions and utilizes Code 44 when appropriate Serves as a resource ... and coordinates the overall transition plan of care based on initial assessment and concurrent collaboration with other care givers, external service organizations,… more
    Beth Israel Lahey Health (08/10/25)
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  • Case Manager - UM II -100%

    Healthfirst (MA)
    …utilizations based on clinical documentation, regulatory, and InterQual/MCG criteria + Assessment - identifying medical, psychological, and social issues that need ... Certified Case Manager + Interqual and/or Milliman knowledge + Knowledge of Centers for Medicare & Medicaid Services (CMS) or New York State + Department of Health… more
    Healthfirst (08/08/25)
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