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Care Management
3 weeks ago
eTeam Inc Boston, United StatesTitle: Care Management - Social Work MSW - Emergency Dept/ Level 1 Trauma Center · Location: Boston, MA 02118 · Duration: 05 months contract · Pay rate: $60 to $65/hr. · Job Description: · 36hr D/E 2p-2:30a Thurs, Fri, Sat. Holidays when needed. · Required Exp: 2 years + post MSW ...
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Care Manager, BH
5 days ago
WellSense Health Plan Boston, United StatesIt's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. · Job Summary: · The Care Manager provides telephonic care manageme ...
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Care Manager SCO
3 weeks ago
WellSense Health Plan Boston, United StatesIt's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. · WellSense Health Plan is recruiting for motivated, compassionate, ...
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Clinical Care Manager
2 weeks ago
Vinfen Boston, United States Full time - RegularJob Description · Schedule: Mon-Fri 8am-4pm · Salary: $90,000 / year · The Registered Nurse (One Care) will act as a team Clinical Care Manager by providing care coordination and clinical management for One Care enrollees with complex healthcare needs. The Registered Nurse (One ...
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RN Care Manager
2 days ago
eternalHealth, The Next Generation of Medicare Advantage Boston, United StateseternalHealth – Your Forever Partner in Healthcare and Beyond · Healthcare is confusing, but it doesn't need to be. A consumer-centric HMO based in Boston, MA, we are a tech-focused start up that is committed to creating long-lasting partnerships with our members, our providers, ...
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Care Manager
4 weeks ago
Cardinal Place Cambridge, United StatesJob Description · Job DescriptionAbout LakeHouse Senior Living: · LakeHouse Senior Living, proudly part of the Discovery Senior Living family of operating companies, manages care- and lifestyle-focused senior living communities in Indiana, Illinois, Wisconsin, Pennsylvania, Ohio ...
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Nursing Service Management I Day Care
2 weeks ago
Titan Industries Somerville, United StatesWe love people. We live for care. · aiutanda stands for quality in outpatient, semi-stationary, and stationary healthcare. We are taking a sustainable path towards more self-determination and stand for a real community, strong cohesion, and courageous changes. · Because together ...
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Utilization Management Care Manager
3 weeks ago
Mass General Brigham Somerville, United States RegularUtilization Management Care Manager Description This is a remote role with occasional (roughly 1x/every other month) onsite team meetings in Somerville, MA. · Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass Gener ...
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Nurse Care Manager TMIN
1 week ago
Tufts Medicine Boston, United States Full timeJob Profile Summary · This role focuses on providing professional and nonprofessional nursing care services in accordance with physician orders. In addition, this role focuses on performing the following Care Manager related duties: Works as part of a multidisciplinary team to ...
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Nurse Care Manager TMIN
1 week ago
Tufts Medicine Integrated Network Boston, United StatesWe're saving lives, building careers, and reimagining healthcare. We can't wait to grow alongside you. · Job Profile Summary · This role focuses on providing professional and nonprofessional nursing care services in accordance with physician orders. In addition, this role focu ...
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RN Care Manager
1 week ago
i4 Search Group Boston, United StatesJob Description · Job Description**Hybrid-Care Manager - Registered Nurse (RN) Bilingual preferred** · POSITION TYPE: Registered Nurse (RN) · SPECIALTY UNIT: Care Manager · LOCATION: Boston Area or Mattapan MA · SHIFT: Day shift no weekends · JOB TYPE: Full-Time Permanent · Jo ...
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Nurse Care Manager
1 day ago
NORTH SUFFOLK COMMUNITY SERVICES INC Boston, United StatesJob Description · Job DescriptionNorth Suffolk is looking for a Psychiatric RN to join our team This position is central to the Psychiatric and Medical Care Integration (PMCI) model being instituted by North Suffolk Community Services (NSCS) as part of the Community Mental Health ...
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Pet Care Manager
1 week ago
LaundroMutt Cambridge, United StatesJob Description · Job DescriptionLaundromutt in Cambridge, MA is calling all animal lovers to apply to join our amazing team as a full-time Pet Care Manager and provide exceptional customer service at our Cambridge, MA location. · WHY YOU SHOULD JOIN OUR TEAM · We are a successfu ...
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Home Care Management Program Manager
4 weeks ago
Boston Senior Home Care Boston, United StatesJob Description · Job DescriptionJob Title: Home Care Program Manager I · Department: Home Care Management · Business Unit: EOEA Direct Services · Reports to: Director of Home Care Management · FLSA: Exempt · JOB DESCRIPTION · Summary/Overview · The Program Manager will superv ...
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Nurse Care Manager TMIN
1 week ago
Tufts Medicine Integrated Network Careers Boston, MA, United States Full timeWe're saving lives, building careers, and reimagining healthcare. This role focuses on providing professional and nonprofessional nursing care services in accordance with physician orders . In addition, this role focuses on performing the following Care Manager related duties: Wo ...
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Temporary Nurse Care Manager
3 days ago
Boston Health Care for the Homeless Program Boston, United StatesJob Description · Job DescriptionWho We Are: · Since 1985, BHCHP's mission has been to ensure unconditionally equitable and dignified access to the highest quality health care for all individuals and families experiencing homelessness in greater Boston. Over 10,000 homeless indiv ...
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Registered Nurse, Care Management
2 weeks ago
Host Healthcare Boston, MA, United States Full timeHost Healthcare is seeking a travel nurse RN Case Management for a travel nursing job in Boston, Massachusetts. · Specialty: Case Management · ~ Shift: 10 hours, days · ~ Employment Type: Travel · Host Healthcare is an award-winning travel healthcare company with an immediate ...
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Nurse Care Manager
1 week ago
Advocates For A Healthy Community Brookline, United States: Nurse Care Manager - RN · Eligible for a $3,500 sign on bonus · Full time, 36 hours per week · Onsite opportunity only, not remote · We offer competitive salary, benefits (including medical, dental, vision), retirement, PTO, and recognize 9 paid holidays. · If you are a co ...
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Care Transitions RN Case Manager
6 hours ago
Beth Israel Deaconess Medical Center Boston, United States Full timeJob Type: Regular · Time Type: Full time · Work Shift: Day (United States of America) · FLSA Status: Non-Exempt · When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. · The RN Case Manager working in the Triad Model of C ...
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Mass General Brigham Boston, United States RegularAdministrative Manager, Pulmonary and Critical Care Medicine, Hybrid Description General Summary · Reporting to and working closely with the Senior Administrative Director of the Division of Pulmonary and Critical Care Medicine, the Administrative Manager will provide support ...
Director, Managed Care - Boston, MA, United States - Optum
Description
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives.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.
Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities.Come make an impact on the communities we serve as you help us advance health equity on a global scale.
You'll enjoy the flexibility to work remotely * from anywhere within the U.Direct provider compliance and payment integrity audit reviews based on applicable standards, state/federal regulations, customer requests, internal requests, or project assignmentsCentrally manage full spectrum of audit operations, from audit strategic planning to coordinating recovery of financial penalties
Direct audit program development in a fast-paced, cross-functional framework in collaboration with client leaders, as well as internal Optum technical, operations, and production teams
Develop claim analyses (algorithms) to identify programmatic and claim processing system vulnerabilities and opportunities to maximize financial recovery for client(s)
Apply data mining and analysis techniques to identify fraud trends and profile providers for possible investigation
Identify quality improvement and training opportunities and work cross-functionally to develop interventions and recommendations
Develop or update work plans, job aids, and policies and procedures
Lead, manage, and actively participate in various meetings both with internal and external stakeholders
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Professional accreditation as either an Accredited Healthcare Fraud Investigator (AHFI) or a Certified Fraud Examiner (CFE), or other comparable certifications~5+ years of experience in developing analytics specifically for detecting fraud, waste, and abuse
~5+ years of management experience with demonstrated ability to navigate a team and business sponsors through a level of ambiguity including algorithm development, specifications programming, data mining, and process improvement
~Experience in using, directing, and managing automated data mining tools for program integrity
~ Ability to travel 10% of the time
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or
Washington Residents Only:
The salary range for this role is $122,100 to $234,700 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable.
In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
Application Deadline:
This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.
Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes.
We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace.