- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- Point32Health (MA)
- …. **Job Summary** Under the supervision of the Utilization Management Supervisor, the Behavioral Health (BH) Utilization ... requirements. The BH UM Clinician works collaboratively with the Behavioral Health leadership within the Behavioral...credential. Must demonstrate sound knowledge of utilization management and care management principles. Health… more
- Evolent (Boston, MA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe RN Utilization Management Reviewer is responsible for facilitating care for members who ... to provide the best quality care. The TeamThe RN Utilization Management Reviewer is part of a...dedicated and motivated team of professionals, including medical and behavioral health care managers, dietitians, pharmacist, clinicians,… more
- Highmark Health (Boston, MA)
- …coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- South Middlesex Opportunity Council (Framingham, MA)
- …casual Working Conditions: As part of the responsibilities of this position, the Utilization Management Coordinator will have direct or incidental contact with ... Summary: SMOC Behavioral Healthcare is a division of SMOC that...division of SMOC that provides substance abuse and mental health outpatient services to individuals, children and families. This… more
- East Boston Neighborhood Health Center (MA)
- …Locations: 1601 Washington Street Position Summary: Under the direction of the Chief Behavioral Health Officer, the Administrative Director is an agent of change ... who oversees the overall clinical quality and operations for the Department of Behavioral Health our South End location, which includes the Integrated … more
- Sevita (Lowell, MA)
- **Mentor South Bay** , provides Early Intervention, Applied Behavioral Analysis (ABA), Behavioral Health and Mental Health Outpatient services across ... job first and foremost in accordance with the Company's mission. The Behavioral Program Supervisor is responsible for the administrative supervision and guidance of… more
- Advocates (Fall River, MA)
- …someone who is creative, flexible and excited about bringing mental and behavioral health support to individuals with developmental disabilities! This salaried ... Behavioral Treatment Specialists. + Provides for the fiscal management of the program and assures the proper ...management of the program and assures the proper utilization of the agency's financial resources. + Responds to… 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 ... to evaluate clinical service requests + Practice anticipatory case management for members whose cases come for review, in...as the highest in member satisfaction among Massachusetts commercial health plans by JD Power , Blue Cross Blue… more
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