- Point32Health (MA)
- …liaises with the interdisciplinary care team, to improve member outcomes (ie, Utilization Management , Medical Director , pharmacy, community health workers, ... the provisions of state-specific Nurse Practice Act(s) where Point32Health operates + National certification in Case Management desirable Education + Required… more
- RTX Corporation (Woburn, MA)
- …Administrator** . This position provides executive-level administrative support to the Executive Director . The Assistant will be expected to work with and for ... located in Woburn, MA.** **What You Will Do** + Facilitate the efficient utilization of the leader's time through development and coordination of a complex,… more
- Datavant (Boston, MA)
- …The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity and ... author appeal letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted...as it relates to job function as delegated by management Ideal candidate should be a Licensed Practical Nurse… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …Active clinical practice in order to participate in panel appeals + Experience in Utilization Management in a managed-care environment (as a clinician or in ... these requests. At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer...to evaluate clinical service requests + Practice anticipatory case management for members whose cases come for review, in… more
- Baystate Health (Springfield, MA)
- …Baystate Health's mission, values, and regulatory obligations. Reporting to the Director , System Security and Public Safety, the Coordinator will lead system-wide ... operations across the system. Current security systems include the Security Management Systems (SMS), Video Management Systems (VMS), Infant Protection… more
- Evolent (Boston, MA)
- …within the **RN/LVN/LPN** scope of practice, under the Medical Director 's direction, using independent nursing judgement and decision-making, physician-developed ... to maintain high-quality, cost-effective care delivery. + Perform pre-certification utilization reviews of **Oncology treatment requests** + Determines medical… more
- Riverside Community Care (Lynnfield, MA)
- …we ensure flexible, accessible care that integrates therapy and medication management to help achieve personal recovery goals. The Clinical Team Manager ... for assigned clinicians, including case consultation/review, ongoing clinical supervision, utilization review/clinical documentation, and staff productivity. The CTM is… more
- Humana (Boston, MA)
- …corporate communications to be shared with senior leadership. + Supports trend management by conducting analysis of drug spend, utilization , and/or approval ... diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead, plans, directs, and monitors… more
- Oracle (Boston, MA)
- …virtual while leading a team responsible for real-time operations, capacity management , and continuous improvement of our physical security network footprint. This ... role also encompasses strategy, process innovation, stakeholder management , and the regular evaluation of new technologies to advance Oracle's position as a leader… more
- Beth Israel Lahey Health (Cambridge, MA)
- …completed). **KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED** 1. RN with experience in risk management , quality assessment, or utilization management . 2. Strong ... making a difference in people's lives.** Reporting to the Director of Quality & Patient Safety, the Quality and...national and local quality, patient safety, and risk management mandates and guidelines. + Collaborates with persons clinically… more