Operations Coordinator, Utilization Management - Somerville, MA

The supervisor will work closely with the Manager, Clinical, · to oversee the daily operations of the utilization management staff. · Expertise in clinical inpatient and outpatient utilization management reviews · utilizing InterQual, company policies and procedures. · Educate st ...

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. · ...

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 ...

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 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. · ...

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 Medicare UM Case Manager RN performs utilization management activities primarily for Medicare Advantage including review of authorizations for home care high tech radiology outpatient inpatient and post acute services. · Associate Degree Nursing required Bachelor Degree Nursi ...

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 ...

+The Insurance Support Nurse participates in the timely management of denials that are received in the Care Coordination Department. · +Collaborates with appropriate individuals, departments and payers to ensure appropriateness of admission, continued days of stay and reimburseme ...

The Medicare UM Case Manager RN performs utilization management activities primarily for Medicare Advantage including review of authorizations for home care high tech radiology outpatient inpatient and post acute services. · Associate Degree Nursing required Bachelor Degree Nursi ...

The Behavioral Health Utilization Manager for Inpatient and 24-Hour Diversionary Services is responsible for overseeing the appropriate and effective utilization of mental health and substance use disorder services across inpatient and residential care settings.This role entails ...

The Behavioral Health Utilization Manager plays a critical role in ensuring the appropriate and effective delivery of mental health services. This position requires advanced clinical judgment and critical thinking to evaluate behavioral health service requests. · Use advanced cli ...

The Behavioral Health Utilization Manager for Inpatient and 24-Hour Diversionary Services is responsible for overseeing the appropriate and effective utilization of mental health and substance use disorder services across inpatient and residential care settings. · This role enta ...

We are improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting ...

The work you do with our team will directly improve health outcomes by connecting people with the care pharmacy benefits data and resources they need to feel their best.Audit entire medical record for accuracy of the coding on the MDS/ MMQ to support payment to the nursing facili ...