- Commonwealth Care Alliance (Boston, MA)
- … quality monitoring, coordination of training initiatives, coordination of Peer to Peer reviews with MDs, and preparation of case samples for audit review. ... training opportunities based on analysis of results + Schedule Peer to Peer calls between requesting MDs...least 2 years of previous professional experience in a health care, case /care management administrative, or related… more
- Veterans Affairs, Veterans Health Administration (Brockton, MA)
- …with persons who experience functional impairments and disabilities associated with mental health , physical, and/or psychosocial challenges affecting employment, ... campus, providing personal adjustment counseling, therapeutic rehabilitation interventions, and case coordination services, The Rehabilitation Counselor uses evidence-informed and… more
- Highmark Health (Boston, MA)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job works collaboratively riskacross Highmark Health clinical areas to support clinical ... The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes and files, delivering feedback reports to business… more
- Highmark Health (Boston, MA)
- …a review of a special project, potential fraud, waste and abuse case , conducting the initial investigations and coordinating the recovery/savings of money related ... law enforcement entities and work with those agencies through closure of the case . Conduct audits for proactive and investigative purposes to comply with internal… more
- Highmark Health (Boston, MA)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** + As a Senior AI Consultant at Highmark, you will play a pivotal role in shaping and executing ... across partners and stakeholders to drive timely decision making and business case design. + Implementation:Facilitate the process to translate proof of concept into… more
- Highmark Health (Boston, MA)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This role will support the leadership team for Clinical Transformation and executive physicians ... three primary Workstreams: leadership over the execution of the Population Health Performance strategy roadmap, support physician executives to identify ownership,… more
- State of Massachusetts (Boston, MA)
- …implementation of Positive Behavior Supports, as well as the Statewide Peer Review, Central Office Risk Review, and interagency collaborative projects. In ... Commissioner or designee, pertaining to eligibility determinations, capacity evaluations, emergency case reviews, and other complex case reviews, including… more
- Highmark Health (Boston, MA)
- …to understand business needs, processes project specifications and business case development. Translate business needs into clearly defined and documented, ... (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains… more
- South Middlesex Opportunity Council (Framingham, MA)
- …standards. * Lived experience of recovery in the context of substance use and mental health + Comfortable presenting in front of groups; organized and a ... Network to vendors, help host community events, help host peer member idea events + Create marketing materials such...or related field. + Minimum one-year assessment, advocacy and case management skills. + Sensitivity to low-income people of… more
- Tufts Medicine (Stoneham, MA)
- …to payers within a timely and secured manner. 10. Closely follows case statuses and communicates and/or documents in hospital system, pending and approved ... coordinators and clinical team members toward their appeal and peer to peer workflow. 12. Monitors productivity...foster a positive work environment. 16. Works closely with Case Management and Admitting colleagues to confirm level of… more