Utilization Manager Jobs in Massachusetts
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Search Results - Utilization Manager Jobs in Massachusetts
Commonwealth Care Alliance Inc.-Boston
The Director of Utilization Management leads and manages all utilization management (UM) functions for physical health services and long-term services and supports to ensure achievement of business results while maintaining compliance with all...
appcast.io -
Bournewood Health Systems-Brookline (MA)
collection of all pertinent clinical data to support HLOC
• Initiates appeals as requested and completes data collection as requested for QI indicators
• Covers Utilization Management Director’s time away as necessary
• Completes daily discharge forms...
mindmatch.ai -
Point32Health-Canton (MA)
Job Summary
The Manager, Inpatient manages Utilization Management (UM) Clinicians in day to day operations of the UM Process and is responsible for medical management activities related to utilization and discharge planning for acute inpatient...
VitalCore Health Strategies-Framingham
Electronic Medical Records (EMR), Utilization Management and other process improvement committees/initiatives as directed or assigned
• Supports Company Initiatives and the application of best practices in clinical settings. Assists in the completion...
2 similar jobs: Gardner, Warwick
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...
VitalCore Health Strategies-Framingham
Electronic Medical Records (EMR), Utilization Management and other process improvement committees/initiatives as directed or assigned
• Supports Company Initiatives and the application of best practices in clinical settings. Assists in the completion...
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...
Gardner (MA)
rotation
Responsibilities:
Essential Functions:
• Utilization Management- Utilization Review and Care Transitions & Coordination
Providing clinical information to payers, monitoring length of stay, seeking necessary care authorizations and utilizing...
icims.com -
Monte Nido & Affiliates, LLC-Waltham (MA)
individual, group, and family therapy for patients with ARFID and other eating disorders
• Serving as liaison with families and outpatient providers
• Interact with insurance companies for pre-certification and utilization management
• Participating...
Marlborough (MA)
qualifications:
• A bachelor's degree (B.A. or B.S.) is required; advanced degree is preferred.
• A minimum of 5 years of experience working in coverage determination and utilization management within a commercial payer organization.
• Established network...
tiptopjob.com -
Gardner (MA)
Monday- Friday, Day Shift (flexible hours), Sign On Bonus!
Job Summary:
As a member of the Heywood Healthcare Family, The Director of Case Management is responsible for the provision of service for Case Management, Social Service and Utilization...
icims.com -
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...
appcast.io -
Plymouth (MA)
of each individual served.
• Routinely reviews and coordinates treatment planning for individuals requiring ongoing medical and consultative services.
• Participates in utilization management initiatives, ensuring compliance with the pharmaceutical...
icims.com -
Brigham and Women’s Hospital-Somerville (MA)
1. Act as expert medical advisor for Medicare related activities:
• Provide Clinical oversight and leadership for the Medicare Advantage line of business.
• Lead the Medicare Advantage Utilization Management (UM) Committee, meeting all CMS...
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Albany Medical Center-West Stockbridge
care for assigned service line across the continuum of care. The Case Manager works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to achieve maximum...
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