- Commonwealth Care Alliance (Boston, MA)
- … Mgmt - Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term ... a high quality team.collaboration with the broader clinical organization. - Ensures that utilization management processes are integrated with care management … more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day ... timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in… more
- Commonwealth Care Alliance (Boston, MA)
- …Work collaboratively with internal departments-including Clinical Operations, Contracting, Network Management , Utilization Management , and Business ... & Language (nice to have):** + Familiarity with care management and utilization management systems...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. - Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management - Serve as the primary relationship manager and point of contact… more
- Commonwealth Care Alliance (Boston, MA)
- …delegated partnerships programs, working with clinical community partners responsible for care management and utilization management across CCA's One Care ... & Language (nice to have): - Familiarity with care management and utilization management systems...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- Commonwealth Care Alliance (Boston, MA)
- …and provider relationship management tools. - Understanding of claims operations, utilization management , and quality programs as they relate to provider ... engagement, delegation partnerships, provider services, contracting, quality, compliance, medical management , and analytics teams to advance provider network operations,… more
- Commonwealth Care Alliance (Boston, MA)
- …(must have): - Meaningful clinical experience including: - 3+ years' experience as a Registered Nurse in a high-touch clinical environment or home care, OR - ... Manager will collaborate closely with other members of the management team. This role is full-time on site in...role. Supervision Exercised: - Assumes responsibility for all nursing ( RN , LPN) and MA roles in the practice. 10… more
- Parexel (Boston, MA)
- **Job Title:** Data Management Lead (Medical Affairs) - Oncology **Location:** Fully Remote (US based) Must be able to accommodate West Coast hours. **About Us:** At ... solutions. We are seeking a dynamic and experienced Data Management Lead to join our team. If you have...practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable… more
- Commonwealth Care Alliance (Boston, MA)
- …and presents results. + Develops and analyzes quantitative reports to assess utilization , productivity and adherence to policies and procedures related to various ... to prior authorizations. **Process Improvement** + Partners with Clinical Operations management to develop and review workflows, to streamline processes and increase… more
- Commonwealth Care Alliance (Boston, MA)
- … Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term ... a high quality team.collaboration with the broader clinical organization. * Ensures that utilization management processes are integrated with care management … more
