- Tufts Medicine (Lowell, MA)
- …health system that is rethinking how academic and community centers, local and national businesses, and technology and service innovators can all work together. So ... with agency policy, State and federal home health regulations. Responsible for the management of cost effective, efficient care to home health patients ensuring the… more
- State of Massachusetts (Lexington, MA)
- …within their assigned residence under the direction of the Residential Services Director . Detailed Statement of Duties and Responsibilities: * Ensure compliance with ... and their families. * Makes recommendations to the Residential Services Director for hiring, disciplinary action, training, supervising and evaluating staff for… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to coverage decisions and final determinations regarding coverage in the BCBSMA utilization management system (MHK), so that decisions and medical reasoning ... as appropriate. At the request of the Senior Medical Director of the Physician Review Unit (PRU), the reviewer...practice in order to process appeals + Experience in Utilization Management in a managed-care or risk… more
- American Red Cross (MA)
- …and processes leveraging the Red Cross ServiceNow platform for Integrated Risk Management . This framework will meet minimum requirements including NIST 800-53, NIST ... plans to remediate issues Overall Governance, Risk, and Compliance: + Assist the Director , IT Governance, Risk, and Compliance and Senior Director , IT… more
- Point32Health (Canton, MA)
- …(https://www.point32health.org/) . **Job Summary** Under the direction of the Pharmacy Utilization Management (UM) Supervisor, the Per Diem Clinical Pharmacist ... projects as assigned by the Pharmacy UM Supervisor or Director **Qualifications** **- what you need to perform the...with Medicare Part B & D, Medicaid, and Drug Utilization Management . Prior authorization experience, including reviewing… more
- Highmark Health (Boston, MA)
- …designs, competitive position, product development, network options, strategic partnerships, utilization review, local/ national client demographics and dentist ... terms through regular on-site audits. Apply an active role in network management , training, monitoring and enforcement of company policies and procedures while… more
- Point32Health (Canton, MA)
- …(https://www.point32health.org/) . **Job Summary** Working under the direction of the Director or Senior Manager, the Senior Network Performance Analyst will be ... Point32Health reports and financial analytics that focus on medical cost, utilization , membership, trends, and comparisons of provider reimbursement positions (using… more
- Cardinal Health (Boston, MA)
- …risk assessments to define audit priorities based on previous audit findings, management priorities, coding utilization patterns, national normative data, ... and compliance issues. **Compliance Audit Manager** Reporting to the Compliance Director , this position supervises and manages compliance audits to determine… more
- Cardinal Health (Tewksbury, MA)
- …facilities throughout the Commonwealth of Massachusetts. This position reports to the Director of Pharmacy or their designee. The primary objective of this position ... the onsite pharmacy technicians, works effectively under the direct supervision of the Director of Pharmacy and/or their designee to meet the drug needs of the… more
- Center For Health Information And Analysis (Boston, MA)
- …full-time Research Assistant, Patient Safety & Maternal Health, who reports to the Center's Director of Research. The successful candidate will be able to work in a ... organize meetings, maintain agendas and take notes + Assist the Center's Director of Research with other tasks as necessary Preferred Qualifications: + Experience… more