- Highmark Health (Boston, MA)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Point32Health (MA)
- … management and care management principles. Health Plan experience performing utilization review activities. Experience with McKesson's InterQual Clinical ... of the Utilization Management Supervisor, the Behavioral Health (BH) Utilization Management (UM) Clinician is responsible for conducting benefit coverage… more
- OptiMindHealth (Cambridge, MA)
- …Part-Time FLSA Status: Non-Exempt Location: Cambridge, MA Join a leading clinician -led behavioral health company today! OptiMindHealth (OMH) is expanding and seeking ... Discuss the possible overlap in our offerings and needs to stakeholders, review our specialty areas and note our differentiating characteristics. 3. Complete and… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …appeals + Experience in Utilization Management in a managed-care environment (as a clinician or in committee work, large group practice, or peer review ) + ... At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas of BCBSMA.… more
- Riverside Community Care (Lynnfield, MA)
- …clinical and administrative oversight for assigned clinicians, including case consultation/ review , ongoing clinical supervision, utilization review /clinical ... at the independent level of licensure for the discipline, specific to the clinician 's training and expertise. + Minimum of one year supervisory or managerial… more
- Beth Israel Lahey Health (Burlington, MA)
- …Hospital and Departmental committees. --Participate in Quality Assurance and or Utilization Review committees as assigned. 25190_LHMC_Clinical Social Worker_C200 ... departmental case conferences --Present cases as requested. --Assist with new clinician orientation. --Participate in administrative functions as defined by the… more
- Beth Israel Lahey Health (Burlington, MA)
- …Hospital and Departmental committees. - Participate in Quality Assurance and or Utilization Review committees as assigned. - Actively participate in child/adult ... case conferences - Present cases as requested. - Assist with new clinician orientation. - Participate in administrative functions as defined by the department… more
- Prime Therapeutics (Boston, MA)
- …Medicaid Clinical Account Manager - Remote **Job Description** Innovative business clinician accountable for building and maintaining customer relationships as well ... fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for additional… more
- Beth Israel Lahey Health (Charlestown, MA)
- …analysis of PI Projects, including quality and technological advantages, patient and clinician benefits, and leveraging this information with utilization data to ... for leading and facilitating the information gathering, analysis, committee review , implementation and communication of PI projects, including Supply Area… more
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