Utilization Manager Jobs in Massachusetts
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Search Results - Utilization Manager Jobs in Massachusetts
Leading Age-Boston
to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, it’s personal.
The salary range for this position is $200,000 to $270,000 annually, based on years of utilization management experience; as part...
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Boston Children's Hospital-Boston
years nursing experience required, pediatrics preferred.
A certification as a Certified Case Manager is preferred, if not must obtain within the first two years of employment.
Experience as a Case Manager (Discharge Planning and or Utilization Management...
Boston Medical Center (BMC)-Boston
in a utilization management/case management position, required.
Knowledge And Skills
• Extensive background and knowledge of current medical/surgical patterns of practice.
• Medical terminology and standard medical abbreviations.
• Managed care concepts...
Northeast Health Services-Boston
They may supervise post-doctoral clinicians and trainees, participate in case reviews, and support utilization management. Proper documentation of all services is required.
Key Responsibilities:
Adhere to ethical and legal standards, including HIPAA...
McLean Hospital-Middleborough
clinical and administrative policies
• Participates in utilization management, risk management, and quality assurance activities
• Participates in appropriate standing hospital committees
• Provides supervision of medical trainees, nursing trainees...
Boston Medical Center (BMC)-Boston
and decision making, preferably in a utilization management/case management position
Knowledge And Skills
• Extensive background and knowledge of current medical/surgical patterns of practice.
• Medical terminology and standard medical abbreviations...
Boston Medical Center (BMC)-Boston
Licenses, Registrations Required
Licensed to practice as a Registered Nurse in the Commonwealth of Massachusetts
Experience
Minimum 5 years or more related experience in a Utilization Management, Denials and Appeals and patient insurance/billing preferred...
Boston Medical Center (BMC)-Boston
and decision making, preferably in a utilization management/case management position, required.
Knowledge And Skills
• Extensive background and knowledge of current medical/surgical patterns of practice.
• Medical terminology and standard medical...
Boston Children's Hospital-Brookline (MA)
and recommendations.
• Participating in hospital/departmental utilization management and quality improvement endeavors where indicated.
• Knowledge of regulatory agency requirements eg Joint commission, DMH, and contractual agreements with 3rd party payers.
• Adequate...
McLean Hospital-Worcester
with all hospital clinical and administrative policies
• Participates in utilization management, risk management, and quality assurance activities
• Participates in appropriate standing hospital committees
• Provides supervision of medical trainees, nursing...
SSTAR-Fall River (MA)
oversees and directs all medical teams in utilization management, population health and wellness, clinician engagement, safety and quality, and patient engagement. As the advocate of the medical teams, the CMO through clinical leadership and direct patient...
McLean Hospital-Boston
with all hospital clinical and administrative policies
• Participates in utilization management, risk management, and quality assurance activities
• Participates in appropriate standing hospital committees
• Provides supervision of medical trainees, nursing...
University of Massachusetts Medical School-Boston
to MassHealth utilization management (UM) strategy/policy development and functions.
• Support and participate in all OCA medical management functions performed on behalf of MassHealth, including but not limited to coverage, medical necessity guidelines...
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McLean Hospital-Lowell
with all hospital clinical and administrative policies
• Participates in utilization management, risk management, and quality assurance activities
• Participates in appropriate standing hospital committees
• Provides supervision of medical trainees, nursing...
Casa Esperanza, Inc.-Roxbury (MA)
and timelines.
• Assist with utilization management, which includes assessing the appropriateness, effectiveness, and medical need for services.
• Work with the Billing Specialist to ensure authorizations are up to date & units have not expired.
• Assist in all...
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