Clinical Guide Part A: Utilization Management - Waltham

Job Description · A bit about this role:  · This position interacts with utilization management, clinical management, pharmacy, network management, data analytics, legal, finance as well as other health plan departments. As a Medical Director in Utilization Management, you share ...

Job Description · Schedule: · This role supports our weekend operations and requires availability every Saturday and Sunday. The weekly schedule is a 5-day (8-hour) schedule, totaling 40 hours per week. Shifts are scheduled within the hours of 8:00 AM–8:00 PM ET. · A bit about t ...

We believe that high-performing teams drive groundbreaking medical discoveries.The Opportunity Manages a department of utilization review professionals usually consisting of Registered Nurses, Social Workers and other paraprofessional roles. · ...

Utilization Management Case Manager – 3 month contract w/ potential to extend and convert · Join our client's team as a vital contributor to high-quality healthcare management. As a Utilization Management Case Manager, you'll play a pivotal role in evaluating medical requests, en ...

Manages a department of utilization review professionals and develops policies and processes for the team. · ...

Manages a department of utilization review professionals usually consisting of Registered Nurses, Social Workers and other paraprofessional roles. Develops and oversees policies and processes for the team and collaborates with other departments to improve the organization's utili ...

Site: Mass General Brigham Health Plan Holding Company, Inc.Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient ca ...

Site: Mass General Brigham Health Plan Holding Company, Inc. · Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient ...

The UMCM will utilize clinical knowledge to analyze and render approval decisions. · Principal Duties and Responsibilities:Expertise in clinical review for prospective utilization management reviews utilizing Interqual. · Review authorization requests for medical services includi ...

The Construction Project Manager supports the Engineer Procure Construct (EPC) Project Manager or Program Manager to oversee day-to-day operations from pre-construction through project completion and warranty periods. · ...

The Construction Project Manager supports the Engineer Procure Construct (EPC) Project Manager or Program Manager to oversee day-to-day operations from pre-construction through project completion and warranty periods. · ...

The UMCM will utilize clinical knowledge to analyze, assess, and render approval decisions. · ...

Job Summary · The Insurance Support Nurse participates in the timely management of denials that are received in the Care Coordination Department.Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical re ...

The Insurance Support Nurse participates in the timely management of denials that are received in the Care Coordination Department.Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. · ...

The Insurance Support Nurse participates in the timely management of denials that are received in the Care Coordination Department. Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. · For n ...

The Insurance Support Nurse participates in the timely management of denials that are received in the Care Coordination Department. Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. · For n ...

The Insurance Support Nurse participates in the timely management of denials that are received in the Care Coordination Department.Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. · ...

This position is critical for centralizing and streamlining operational, HR, and compliance functions within the Mass General Brigham UM Enterprise. · ...

This position is critical for centralizing and streamlining operational, HR, and compliance functions within the Mass General Brigham UM Enterprise.Primary Responsibilities: · 1. Centralized EPIC Role Management · o Coordinate all EPIC access requests and maintain security compli ...

This position is critical for centralizing and streamlining operational, HR, and compliance functions within the Mass General Brigham UM Enterprise. It ensures efficiency, accuracy, · and continuity across multiple domains.Primary Responsibilities: · Centralized EPIC Role Managem ...