Physician Reviewer - Hingham, MA

The Physician Reviewer is responsible for evaluating pre & post-service clinical service requests made by BCBSMA members and providers. · Apply BCBS Criteria and guidelines to case reviews of BCBS members in order to determine if coverage of the requested service is appropriate,A ...

The Post-Service Claims Nurse Reviewer is a pivotal role responsible for safeguarding the integrity of our claims process in a post-service, pre-payment environment. · ...

Job summary The Post-Service Claims Nurse Reviewer is a pivotal role responsible for safeguarding the integrity of our claims process in a post-service pre-payment environment In this position you will leverage your deep clinical expertise and business acumen to ensure all claims ...

The Physical Therapy Utilization Management Reviewer evaluates services for appropriateness and medical necessity. · Evaluate members' clinical status and benefits. · Analyze clinical outcomes and quality of service. · ...

The Physical Therapy Utilization Management Reviewer is responsible for evaluating the appropriateness and medical necessity of outpatient rehabilitation and other services within scope of practice per business needs. · The role requires collaboration with a team of professionals ...

The PT Utilization Management Reviewer is responsible for facilitating care for members who may have complex healthcare needs. · This position is self-directed and works independently to facilitate care using clinical skills · ...

The RN Utilization Management Reviewer is responsible for facilitating care for members who may have complex healthcare needs, · Conduct pre-certification, concurrent, and retrospective reviews with emphasis on utilization management, discharge planning, care coordination, · ...

Join our team as a per diem cardiac echo technologist at South Shore Health. · Performs complete studies including M-MODE, REAL TIME, COLOR FLOW MAPPING and DOPPLER. · ...

Participates in technical duties directly involved with the CT Scanner including developing, initiating and monitoring procedures for the effective utilization of this unit. · Maintains equipment for proper diagnostic imaging. · ...

Participates in technical duties directly involved with the CT Scanner including developing, initiating and monitoring procedures for the effective utilization of this unit. · ...

The Post-Service Claims Nurse Reviewer is a pivotal role responsible for safeguarding the integrity of our claims process in a post-service, pre-payment environment. · This position requires close collaboration across departments and working collaboratively with the FEP Business ...

This position is self-directed and works independently and collaboratively to facilitate care based on the principles of care management. Facilitation is focused on assessing needs, identifying health care disparities, social determinants of health, and any barriers to care.The C ...

The Clinical Care Manager is responsible for facilitating care for members and families of members who may have rising health risks or complex healthcare needs, · Engage members in appropriate plans of care, · coordinate care and services as appropriate, · , communicate effective ...

The Clinical Care Manager is responsible for facilitating care for members and families of members who may have rising health risks or complex healthcare needs, to promote optimal health. · ...

The Clinical Care Manager is responsible for facilitating care for members and families of members who may have rising health risks or complex healthcare needs. · * Engage members in appropriate plans of care, · * Interpret and apply case management criteria, · * Review medicatio ...

The RN Case Manager is responsible for facilitating care for members and families of members who may have rising health risks or complex healthcare needs. · Engage members in appropriate plans of care. · Promote member compliance with treatment plan. · ...

The Clinical Care Manager is responsible for facilitating care for members and families of members who may have rising health risks or complex healthcare needs, to promote optimal health. · ...

We are seeking a RN Utilization Management Reviewer to help transform healthcare. The role involves facilitating care for members with complex needs and authorizing necessary services. · Self-directed and independent. · Excellent communication skills. · Able to assess medical inf ...

Under the supervision of the MRI Manager, · the MRI Team Leader and MRI Safety Officer, · the technologist performs a variety of routine · and advanced MRI procedures in the presence · of a strong magnetic field while monitoring · and maintaining essential patient care · & safet ...

The Clinical Business Consultant for Cost and Trend Management is responsible for identifying high-cost cases and analyzing clinical information to provide a summary of a member's course of illness. · ...