- 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)
- …the Utilization Management Supervisor, the Behavioral Health (BH) Utilization Management (UM) Clinician is responsible for conducting benefit coverage ... management and care management principles. Health Plan experience performing utilization review activities. Experience with McKesson's InterQual Clinical… 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
- 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 ... compassionate professionals to join our team. Today, OMH provides superior behavioral health services to patients in Massachusetts, Colorado, and Montana. Since… 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