Utilization review nurse jobs in Swansea, MA - 375 jobs

**Full Time Dispensing Nurse - * LPN/LVN* *Health Care Resource Centers *is looking for a detail oriented and empathetic Licensed Practical Nurse / Licensed Vocational Nurse to dispense prescribed medications as part of a treatment team in partnership with Physicians and Nursing Supervisors. The dispensing nurse also shares responsibility of maintaining dispensing equipment, managing medication inventory and reporting patient treatment information. An ideal dispensing nurse candidate works cooperatively with supervisory counseling staff and demonstrates a non-judgmental and accepting attitude toward the Substance Use Disorder. *Responsibilities: * * Administer daily medication to patients in accordance with program policy and medical protocols. * * Use automated dispensing system(s), calibrate pump and maintain dispensing equipment * Produce and maintain appropriate records and reports as required by Company protocol, Federal and State Regulations * Ensure compliance with security standards for the distribution and storage of controlled substances as set forth in the Code of Federal regulations * Order, receive and stock medication in accordance with DEA and State regulations. (If granted Power of Attorney) * Provide daily assessment of patients * Assist Nursing Supervisor to orient new nursing staff * Other related duties as determined by supervisor *Qualifications: * * Current & good standing LPN/LVN license in the State of Massachusetts.* * Current CPR certification required. * EMR & computer proficiency desired. * Experience in chemical dependency preferred, self-motivated and directed, must have a positive attitude toward individuals in substance abuse treatment. * Satisfactory drug screen and criminal background check. *Salary Range: * Salary ranges from $28.00 to $29.00 an hour. The salary of the candidate(s) selected for this role will be set based on a variety of factors, including but not limited to, experience, education, specialty, and training.* *BayMark offers excellent benefits:* * 401K match * Medical, Dental, Vision Insurance * Voluntary Worksite Benefits (i.e., Accidental Injury) * Company paid Short & Long Term Disability * Company paid Basic Life Insurance * Paid Time Off * Bereavement Leave * Flexible Sick Time * Employee Referral Program * BayMark Perks Program * Jury Duty & Witness Duty Leave * BayMark University Learning * *Here is what you can expect from us:** *Health Care Resource Centers*, a progressive substance abuse treatment organization, is committed to the highest quality of patient care in a comfortable outpatient clinic setting. Our ultimate goal is to address the physical, emotional, and mental aspects of opioid use disorder to help each of our patients achieve long-term recovery and an improved quality of life. *Health Care Resource Centers* is committed to Equal Employment Opportunity (EEO) and to compliance with all Federal, State and local laws that prohibit employment discrimination on the basis of race, color, age, natural origin, ethnicity, religion, gender, pregnancy, marital status, sexual orientation, citizenship, genetic disposition, disability or veteran's status or any other classification protected by State/Federal laws.**

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 care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary 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. The Medicare UMCM reviews the medical necessity of authorization requests using NCD, LCD, Medicare Benefit Policy Manual, medical policies, and InterQual criteria. Qualifications Education Associate's Degree Nursing required; Bachelor's Degree Nursing preferred Licenses and Credentials Massachusetts Registered Nurse license required Basic Life Support [BLS Certification] Certification preferred Experience At least 2-3 years of utilization management strongly preferred Experience applying National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Medicare Benefit Policy Manual preferred InterQual experience preferred Knowledge, Skills, and Abilities Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times. Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems. Ability to establish strong rapport and relationships with patients and staff. Proficient in Microsoft Office and industry-related software programs. Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions. Ability to maintain client and staff confidentiality. Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care. Knowledge of Healthcare and Managed Care preferred. Additional Job Details (if applicable) Working Conditions This is a remote role that can be done from most US states Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $58,656.00 - $142,448.80/Annual Grade 98TEMP At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

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 care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary 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. The Medicare UMCM reviews the medical necessity of authorization requests using NCD, LCD, Medicare Benefit Policy Manual, medical policies, and InterQual criteria. Qualifications Education * Associate's Degree Nursing required; Bachelor's Degree Nursing preferred Licenses and Credentials * Massachusetts Registered Nurse license required * Basic Life Support [BLS Certification] Certification preferred Experience * At least 2-3 years of utilization management strongly preferred * Experience applying National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Medicare Benefit Policy Manual preferred * InterQual experience preferred Knowledge, Skills, and Abilities * Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times. * Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems. * Ability to establish strong rapport and relationships with patients and staff. * Proficient in Microsoft Office and industry-related software programs. * Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions. * Ability to maintain client and staff confidentiality. * Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care. * Knowledge of Healthcare and Managed Care preferred. Additional Job Details (if applicable) Working Conditions * This is a remote role that can be done from most US states Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $58,656.00 - $142,448.80/Annual Grade 98TEMP At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Benefits: Direct Deposit Weekly Pay Competitive salary Inpatient RN - Utilization Review Nurse (Behavioral Health) - Cambridge, MA Schedule: Day Shift, Monday-Friday, 8:30 AM - 5:00 PM Pay: $72/hour Job Summary: We are seeking a skilled Inpatient RN Utilization Review Nurse to join our behavioral health team in Cambridge. This role focuses on acute care review and utilization management to ensure high-quality patient care. Requirements: Must be a local candidate within 50 miles of Cambridge, MA Acute care experience required Experience with InterQual criteria EMR experience required (EPIC preferred) Strong clinical judgment and utilization review skills Responsibilities: Review and evaluate patient care for appropriateness and efficiency Collaborate with interdisciplinary teams to support patient care and discharge planning Ensure compliance with hospital policies and clinical guidelines Apply now to join a team dedicated to delivering exceptional behavioral health care. Compensation: $72.00 per hour Great jobs. Great company. Great community of caregivers. At Aura Staffing Partners, we know that partnering with you to find the right opportunity in healthcare is just the beginning. We don't leave you high and dry, instead we help you grow even brighter with quarterly reviews, continued training and plenty of communication.

· Participates in the development and ongoing implementation of QM Work Plan activities. · Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives Responsibilities: · Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. · Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation. · Data gathering requires navigation through multiple system applications. · Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information. · Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines. · Responsible for the review and evaluation of clinical information and documentation. · Reviews documentation and interprets data obtained form clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues. · Works Potential Quality of Care cases across all lines of business (Commercial and Medicare). · Independently coordinates the clinical resolution with internal/external clinician support as required. · Processes and evaluates complex data and information sets -Converts the results of data analysis into meaningful business information and reaches conclusions about the data · Prepares and completes QM documents based on interpretation and application of business requirements · Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements · Assists in the development and implementation of QM projects and activities · Accountable for completing and implementation of QM Work Plan Activities Experience: · 3+ years of experience as an RN · 1+ years of inpatient hospital experience · Registered Nurse in state of residence · Must have prior authorization utilization experience · Able to work in multiple IT platforms/systems Skills: · MUST HAVE MEDCOMPASS or ASSURECARE exp. · MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. · MUST HAVE UM experience, inpatient utilization management review. · MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. · MUST HAVE 6 months of Prior Authorization. Education: · Active and unrestricted RN licensure in state of residence **About US Tech Solutions:** US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit *********************** (*********************************** . US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus

Summary: SMOC Behavioral Healthcare is a division of SMOC that provides substance abuse and mental health outpatient services to individuals, children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. Candidates must possess at least 2-3 years' experience billing 3 rd party insurance, work with Department of Public Health contracts. Why Work for SMOC? Paid Time Off: All full-time employees can accrue up to 3 weeks of vacation, and 2 weeks of sick time and are eligible for 12 paid holidays during their first year of employment. Employer-paid Life Insurance & AD&D and Long-Term Disability for full-time employees. Comprehensive Benefits Package including Medical Plans through Mass General Brigham with an HRA Employer cost-sharing program, Dental Plans with Orthodontic Coverage, and EyeMed Vision Insurance available to full-time employees. 403(B) Retirement Plan with a company match starting on day one for all full-time and part-time employees. Additional voluntary benefits including; Term and Whole Life Insurance, Accident Insurance, Critical Illness, Hospital indemnity, and Short-Term Disability. Flexible Spending Accounts, Dependent Care Accounts, Employee Assistance Program, Tuition Reimbursement and more. Primary Responsibilities: Interface with the billing subcontractor. Work hand in hand with representatives from the billing contractor and the clinic front office to make adjustments in the health record to ensure all activities are billable to all payors. Ensure all client payor information and authorizations are entered into the electronic health record. Reconcile and resolve issues related to claims submissions, research and resolve eligibility issues, including contact with clients to inform of eligibility loss. Ensure all new and ongoing prior authorizations are entered for the Outpatient Clinic programs, Residential Recovery Programs. Ensure all billing to Department of Public Health is entered accurately and in a timely fashion, for the RRS and outpatient clinic programs. Review denials and partially paid claims and resolve discrepancies. Assist in resolving overdue claim problems. Run reports and gather data as needed for financial and operating reports. Recommend write-off and process in billing system as directed. Ensure compliance with program/department, agency and/or funder requirements, as well as, SMOC policies & procedures. Other duties as assigned. Knowledge and Skill Requirements: Associates Degree preferred or relevant experience Medical and/or Mental Health third party billing experience Experience with third party billing denial and resolution process Must have ability to handle multiple and changing priorities and meet deadlines Organizational Relationship: Directly reports to Operations Director. Indirectly reports to Director of Residential Recovery Programs. Direct reports of this position are none. Physical Requirement: Ability to ascend and descend stairs Ability to see and read Ability to lift up to 10lbs Dress is business casual Working Conditions: As part of the responsibilities of this position, the Utilization Management Coordinator will have direct or incidental contact with clients served by SMOC in various programs funded or administered through the Executive Office of Health and Human Services. Remote Work Option: Remote work is permissible in some positions at SMOC depending on the key functions and responsibilities. The Compliance Officer position is eligible to work from home 0-60% of the week in scheduling coordination with the department manager. Monday through Friday: 9:00AM - 5:00PM. Includes a 1-hour unpaid lunch break. 35 Hours per week.

Behavioral Health Community Partnership (BHCP) Nurse Case Manager Department: Social Services Supervisor: Director of Nursing Status/Hours Per Week: Non-exempt / 35 hours Pay Range: The expected base pay for the position is $36-$65.02 per hour and may be increased based on other factors, such as language, certifications, etc. Primary Function: The Behavioral Health Community Partnership Nurse Case Manager [BHCP RN Case Manager] functions under the supervision of the Director of Nursing and overall guidance and consultation with the Medical Director and other Primary Care Providers to conduct patient monitoring, tracking, and provide ongoing care coordination and support to patients with behavioral health issues that are enrolled in BHCP. The BHCP RN Case Manager ensures patients' adequate linkages with behavioral health counseling, all levels of substance use care, including medication assisted treatment, and chronic pain management care. Duties & Responsibilities: * Receive and maintain a log of all patients enrolled in BHCP, and ensure adequate follow up and care coordination. * Serve as Clinical Care Manager for enrollees referred to the team, participating in the assessment, care planning, and on-going BHCP service provision specified in program protocols and policies. * Review and approve Comprehensive Health Assessments for members including performing medication reconciliations. * Make patient referrals to behavioral health, and human services providers at the Health Center for needed services such as primary care and other substance use and mental health care. * Make "warm handoffs" and coordinate support to needed services at external organizations including hospitals, substance use treatment programs, etc. * Follow up with members post-discharge to ensure members are seen by a Primary Care provider in a timely manner. * Monitor and track patients including progress in their treatment plan and update PCPs and other members of the team. * Participate in multi-disciplinary team meetings, utilization review, and program planning. * Participate in consultation, sharing of resources and best practices with other Riverside Community Partner teams.

Site: Martha's Vineyard Hospital, 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 care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. 24 hour hours per week; weekend and holiday ; 2 days on site Job Summary Serves as a core member of the care team coordinates and supports healthcare within the facility, and coordinates referrals for services outside the clinic. Provides outreach and enrollment services to meet eligibility requirements of the program and surrounding counties. Ensures coordination and planning, including community and family support. Focuses on the development and coordination of community service plans. Partners with service providers, families, and patients to create a plan of healthcare and identify additional service providers. Does this position require Patient Care?Yes Essential Functions -Client Assessments and Planning -Modify patient treatment plans as indicated by patients' responses and conditions. -Prepare patient/family for discharge -Communicates with third party payers to obtain necessary authorization for reimbursement of services. -Review cases with medical directors on challenging cases as needed -Defines care goals of patients by providing education, information, and direction to each individual and family. -Maintain accurate, detailed reports and records. -Communicates with third party payers to obtain necessary authorization for reimbursement of services. Qualifications Education Associate's Degree Nursing required or Bachelor's Degree Nursing preferred Can this role accept experience in lieu of a degree? No Licenses and Credentials Registered Nurse [RN - State License] - Generic - HR Only required Basic Life Support [BLS Certification] - Data Conversion - Various Issuers preferred Experience Case management, utilization review, or discharge planning experience 2-3 years preferred Knowledge, Skills and Abilities - Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times. - Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems. - Ability to establish strong rapport and relationships with patients and staff. - Proficient in Microsoft Office and industry related software programs. - Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions. - Ability to maintain client and staff confidentiality. - Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care. - Knowledge of Healthcare and Managed Care preferred. Additional Job Details (if applicable) Physical Requirements Standing Frequently (34-66%) Walking Frequently (34-66%) Sitting Occasionally (3-33%) Lifting Frequently (34-66%) 35lbs+ (w/assisted device) Carrying Frequently (34-66%) 20lbs - 35lbs Pushing Occasionally (3-33%) Pulling Occasionally (3-33%) Climbing Rarely (Less than 2%) Balancing Frequently (34-66%) Stooping Occasionally (3-33%) Kneeling Occasionally (3-33%) Crouching Occasionally (3-33%) Crawling Rarely (Less than 2%) Reaching Frequently (34-66%) Gross Manipulation (Handling) Frequently (34-66%) Fine Manipulation (Fingering) Frequently (34-66%) Feeling Constantly (67-100%) Foot Use Rarely (Less than 2%) Vision - Far Constantly (67-100%) Vision - Near Constantly (67-100%) Talking Constantly (67-100%) Hearing Constantly (67-100%) Remote Type Remote Work Location One Hospital Road Scheduled Weekly Hours 24 Employee Type Regular Work Shift Day (United States of America) Pay Range $58,656.00 - $142,448.80/Annual Grade 98TEMP At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: Martha's Vineyard Hospital, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

ECMO, which stands for extracorporeal membrane oxygenation, is an advanced technology that functions as a replacement for a critically ill child's heart and lungs. It's used to support a child who is awaiting surgery, or to give a child's vital organs time to recover from heart surgery or disease. Boston Children's Hospital is home to one of the largest pediatric ECMO programs in the world; we provide services to critically ill children in the New England region, and to those who are referred from other states and internationally. We serve between 50 and 60 patients with severe respiratory or cardiac problems each year. Since its establishment in 1984, the ECMO Program has supported more than 900 children. Throughout the 20-year history of the ECMO Program at Boston Children's, we have gained considerable expertise, minimized complications, and increased its success rate for survival to 60 percent, higher than the national average of around 40 percent. Key Responsibilities: * Plans and organizes daily clinical and administrative responsibilities within the designated unit/program/service. * Develops, recommends, and implements internal standards, policies, and procedures to improve quality of patient care in collaboration with ECMO clinical leadership. * Develops and provides staff education/development programs in collaboration with unit specific nursing leadership. * Performs clinical review of inpatients who are either at risk of requiring ECMO or have been exposed to ECMO. * Collects clinical data relevant to patient outcomes and adverse events associated with critical illness and/or ECMO. * Works collaboratively with a multidisciplinary health care team to optimize patient care outcomes. * 40 hours per week. Minimum Qualifications Education: * A Bachelor's degree in nursing. Experience: * 4-5 years of pediatric critical care or pediatric cardiac critical care RN experience required. * Excellent attention to detail and the ability to adhere to stringent care protocols and documentation standards. * Strong communication skills and the ability to work collaboratively in a team-oriented clinical environment with liaison with strong quality-improvement team. Licensure/ Certifications: * Current Massachusetts license as a Registered Nurse (RN) The posted pay range is Boston Children's reasonable and good-faith expectation for this pay at the time of posting. Any base pay offer provided depends on skills, experience, education, certifications, and a variety of other job-related factors. Base pay is one part of a comprehensive benefits package that includes flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.

The Guild utilizes the collaborative efforts of leading professionals, best-practice approaches, tailored curricula and unmatched care to treat the individuals we serve. Mission: The mission of The Guild for Human Services is to educate, encourage and empower individuals with intellectual disabilities so they may achieve their full potential to lead high-quality lives and participate meaningfully in the community. At The Guild you can join a workforce of creative, dedicated, and passionate employees working every day to enhance the lives of youth and adults with intellectual disabilities and other challenges. Summary: Nurse Case Manager acts as a committed member of a multi-disciplinary team to help create and maintain goals of health & wellness for an assigned group of students. Primary Job Responsibilities: * The Nurse Case Manager/ Registered Nurse acts as Nurse Consultant for assigned Group Home students. * Monitor the health and safety issues within all locations of the school and residence. * Provide staff training to ensure optimal health and safety standards. * Provide staff training pertinent to health and safety needs, medical conditions, medical diagnosis and treatment plans. * Assist in scheduling laboratory testing and medical appointments and participates in health examinations as indicated. * Maintain medical records including documentation of treatment and medication administration of students. * Communicate with outside agencies and physicians as necessary. * Complete initial and annual medical assessments for students. * Complete annual Individual Health Plans and quarterly assessments. * Monitor, plan for, and communicate with the team regarding medical appointments, medical issues and other health related matters. * Communicate with outside agencies, physicians and parents/guardians. * Participate in designated team meetings and case reviews for students. * Monitoring Medication systems in residences and school. * Ensure timely submission of Medication Error Reports. * Assess certified staff medication administration competence . * Provide medical on-call coverage at minimum one week monthly * Able to attend training as required * Other related duties as assigned Essential Job Functions * Regular attendance at work is an essential function of the job including inclement weather situations * Physical and mental capacity to work in stressful situations and de-escalate individuals who have limited cognition and complex needs * Proficiency in written and spoken English is an essential function of the job. * Excellent organization and time management skills * Pass Guild Driving test to access Guild vehicles for transportations of individuals. * Must be able to implement crisis intervention techniques as necessary, including Nonviolent Crisis Intervention (via certification through CPI) * Registered Nurses who have an associate's degree (bachelor's preferred) with 2 years Nursing experience * Preference for additional training specific to nursing practice, such as CDDN * Knowledge of Massachusetts regulatory standards is required with preferred experience in regulatory compliance with standards from Department of Developmental Services (DDS) and Department of Public Health (DPH) * Undergo a background check process * Proficiency in Microsoft Office Suite

Full-time, Part-time Description Job Title: Wellness Nurse Hours: Per Diem The Resident Care Nurse is responsible for assisting the Resident Care Director with the overall implementation, delivery and coordination of Resident Care services at the Community. Nurse will also assist in monitoring the medication management program. Duties and Responsibilities: The following essential functions are the fundamental job duties of the position to be completed with or without appropriate reasonable accommodation. • Assist in supervising the medication program and assisting the residents with self-administration of their medication. • Assist residents with Activities of Daily Living and Independent with Activities of Daily Living as needed. • Maintain positive relations with residents, families and physicians. • Report any significant incidents and/or changes in the residents needs to the Executive Director/Resident Care Director. • Assist in the completion of resident assessments and services plans. • Assist in the training of assisted living staff and participates in orientation of new staff. • Attend and participates in scheduled in-service programs, training programs and staff meetings. • Assist with scheduling and staffing of Resident Care Assistants • RN will maintain GAFC. • May perform other duties as assigned. Requirements Minimum Qualifications: • Registered Nurse/Licensed Practical Nurse/Licensed Vocational Nurse with a current license in good standing. • Certification or licensed per state guidelines. • Must successfully complete all HallKeen • Community specified training programs. • Able to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Able to deal with problems involving a few concrete variables in standardized situations. • Able to work various schedules and shifts as needed. • Required Behavior: • Appearance is neat, clean, and according to dress code. • Able to demonstrate a high level of service delivery; does what is necessary to ensure customer satisfaction; deals with service failures and prioritizes customer needs. • Able to clearly present information through the spoken word; reads and interprets complex information; talks with residents, family members and customers; listens well. • Able to communicate with others in a warm and helpful manner while simultaneously building credibility and rapport. • Able to work cooperatively with a group of people to achieve goals and objectives. • Able to be tactful; maintains confidences, and fosters an ethical work environment; prevents inappropriate behavior by coworkers; gives proper credit to others; handles all situations honestly. • Able to keep an open mind and change opinions on the basis of new information; performs a variety tasks and changes focus quickly as demands change; manages transitions effectively from task to task; adapts to varying customer needs. Physical Demands: • Physically able to move at least 50 lbs. without assistance. • Physically able to bend, reach, and work in small areas. • Physically able to push and pull equipment and furnishings. • Physically able to stand for long periods of time.

Job DescriptionDescriptionCamp Ponkapoag - YMCA of Greater Boston Seasonal - Summer 2025 Are you a compassionate, energetic nurse looking for a rewarding summer experience? Join us at Camp Ponkapoag, nestled in the scenic Blue Hills Reservation, just minutes from downtown Canton. We're seeking a dedicated Day Camp Nurse to help keep our campers and staff safe, healthy, and thriving all summer long. This is a fantastic opportunity for school nurses, pediatric professionals, or any nurse who enjoys working with children in a dynamic, outdoor environment. Key Responsibilities Prioritize the health, safety, and emotional well-being of all campers and staff. Maintain daily health logs and accurate medical records for all camp participants. Dispense medications according to prescribed schedules and maintain secure storage. Prepare and audit first aid medical bags for supplies and correct emergency medications. Administer first aid and respond to minor medical needs on-site. Assess health concerns and determine when to escalate care or involve emergency services. Communicate effectively with parents, caregivers, and camp staff regarding health concerns. Liaise with local healthcare providers as needed. Stay informed of camper medical needs (e.g., allergies, special diets) and educate staff as needed. Accompany campers or staff to hospitals when necessary. Participate in camp activities and events to stay engaged and connected with the camp community. Serve as a positive role model, reflecting YMCA values and camp spirit at all times. Skills, Knowledge and ExpertiseQualifications Licensed Registered Nurse (RN) or Licensed Practical Nurse (LPN) in the state of Massachusetts (or willing to obtain licensure). Experience in pediatrics, emergency medicine, or school nursing preferred. CPR/First Aid Certification (or willingness to obtain prior to camp start date). Strong communication and interpersonal skills. Ability to work independently and make sound decisions under pressure. Previous experience working with children (not necessarily in a medical role). Additional Qualities Friendly, approachable, and calm under pressure. Adaptable to the unique rhythm of camp life. A team player who's excited to contribute to a positive, community-centered environment. BenefitsMake a difference this summer-join the Camp Ponkapoag team and help create a safe, healthy, and unforgettable experience for our campers!

The Registered Nurse (RN) will utilize the nursing process of assessment, planning, implementation, and evaluation to ensure quality nursing care and to maximize the quality of life for the patients. The RN is an integral member of the clinical support team and collaborates with other multidisciplinary members to meet the clinical needs of the patients. The RN is an active supporter of the culture change initiatives and serves as a role model and mentor to others. In addition, the RN will demonstrate a strong commitment to the philosophy and mission of Hebrew SeniorLife, recognizing patients' dignity and choice in all aspects of daily life. They are an active participant in the activities, work, and social environment of the units and strive to make every patient encounter a positive and meaningful experience and opportunity, while ensuring the provision of safe and efficient quality care. II. Core Competencies: Demonstrates empathy and compassion in all interactions with patients and with families Articulates the importance of supporting independence and patient choice when caring for patients Demonstrates strong communication skills and the ability to foster teamwork Articulates commitment to excellence and high-quality care Articulates the importance of accountability and personal ownership related to teamwork and patient care Demonstrates strong critical thinking skills Demonstrates ability to coach and mentor others to achieve high-quality care Position Responsibilities: Ensures all care delivered is within the scope and established standards of safe professional nursing practice and HSL core competencies Collaborates with other members of the clinical support team (MD, NP, nurses, social worker, therapists, dietitian) to meet the clinical needs of the patient and monitor outcomes of care Adheres to best practice recommendations and implements evidence-based interventions to ensure optimum outcomes for patients Practices in a primary nursing model and maintains accountability for a set of assigned patients Collaborates and participates in care planning activities and supports autonomy and individual choice wherever possible Ensures adherence to the plan of care, revises as necessary, and ensures the plan accurately reflects an individualized approach to the patient's needs Documents appropriately in the electronic medical record Identifies and seeks out necessary resources as needed to ensure the provision of safe and effective care Delegates and supervises clinical care delivered by the licensed practical nurse and the nursing assistant Assumes accountability for his/her own learning needs and professional development Demonstrates critical thinking abilities in problem resolution Role models professional behavior Actively participates in shared governance, committees, etc Collaborates in the development of new work processes and systems Serves as a resource and support to the elder assistants in the units Identifies and responds to safety concerns in the unit and neighborhood Maintains compliance with policies, procedures, practices, and regulatory matters Participates in the collection and monitoring of quality data to ensure high standards of care Participates in performance improvement projects Participate and assist with activities (i.e., assist with serving meals) Serves as a coach and mentor to all staff, i.e., PCAs and LPNs May be assigned charge nurse responsibilities. Responsibilities may include: Giving the shift report to the incoming staff Provide clinical/supervisory oversight to the assigned unit during the shift Delegate assignments to the team assigned to the shift Initiate necessary reports, including DPH, incident reports, and concern resolutions Assure completion of admission or discharge during the shift Provides oversight of LPN assessments (as assigned) and co-signs nursing assessments and initial care plans. If acting in the capacity of charge nurse, may develop patient care assignments (appointing other staff, RN, LPN, or PCA to implement an established care plan for a designated period of work time), create schedules, and contribute to performance evaluations and educate other staff on HSL policy and procedure. The above covers the most significant responsibilities of the position. It does not, however, exclude other duties, which would conform to the level of the position. Completes special projects as assigned. IV. Qualifications : Graduate of an approved school of nursing required; BSN preferred Current Massachusetts license as an R.N. in good standing Previous experience preferred Understand the philosophy and support the model of care at HRC required Must be a professional, proactive, collaborative, conscientious, and results-oriented individual. Must have an optimistic demeanor, excellent oral and written communication skills, good intuition, and be able to adapt to changing priorities and display good, sound judgment with a sense of humor. Superb organizational skills. Must have solid analytical skills. Must be creative and proactive yet disciplined, discriminating, and able to streamline work volume in order to maintain bottom line efforts in the midst of multi-tasking and daily re-prioritizing. Must have the ability to innovate, think strategically and conceptually, manage multiple projects simultaneously and handle even difficult situations. Must be motivated to learn and flexible to change Computer literacy required Excellent English language skills, written and verbal Remote Type Salary Range: $32.13 - $48.20

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 care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary The UMCM will utilize clinical knowledge to analyze, assess, and render approval decisions, to determine the need for physician review as well as complete determinations following physician review. The ideal candidate will have prior authorization (outpatient review) experience in a managed care setting with Medicaid/MassHealth knowledge. Principal Duties and Responsibilities: • Expertise in clinical review for prospective, concurrent, retrospective utilization management reviews utilizing Interqual , company policies and procedures, and other resources as determined by review, including physician reviews as needed for all lines of business as per departmental needs • Review authorization requests for medical services, including making initial eligibility and coverage determinations, screening for medical necessity appropriateness, determining if additional information is required, and referral to correct programs within Mass General Brigham Health Plan as needed. • Manage incoming requests for procedures and services including patient medical records and related clinical information. • Strong working knowledge of commercial, self-insured, fully insured and limited network plans. • Adherence to program, departmental and organizational performance metrics including productivity. • Excellent verbal and written communication skills. • Excellent problem solving and customer service skills. • Would need to be available for “on call” for a minimum of once per month with the possibility of that increasing depending on staff availability; Approximately 6 months after hire. • Must be self-directed and highly motivated with an ability to multi-task. • Develop and maintain effective working relationships with internal and external customers • Hold self and others accountable to meet commitments. • Sound decision-making and time management skills. • Proactive in areas of professional development, personally and for the department. • Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise. • Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization. • Proficient with Microsoft Word, Excel, Outlook, McKesson InterQual , Outlook, SharePoint, PC based operating system, and web-based phone system. Qualifications Education Associate's Degree Nursing required or Bachelor's Degree Nursing preferred Licenses and Credentials Massachusetts Registered Nurse (RN) license required Experience At least 2-3 years of utilization review experience is highly preferred Experience using Interqual or Milliman is highly preferred At least 1-2 years of experience in a payer setting is highly preferred At least 1-2 years of experience in an acute care setting is highly preferred Knowledge, Skills, and Abilities Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value Strong aptitude for technology-based solutions. Embrace opportunities to take the complexity out of how we work and what we deliver. Listen to our constituents, learn, and act quickly in our ongoing pursuit of meaningful innovation Current in healthcare trends. Ability to inject energy, when and where it's needed. Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback. Be accountable for delivering high-quality work. Act with a clear sense of ownership. Bring fresh ideas forward by actively listening to and working with employees and the people we serve. Communicate respectfully and professionally with colleagues Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback. Additional Job Details (if applicable) Working Conditions Would need to be available for “on call” for a minimum of once per month with the possibility of that increasing depending on staff availability; Approximately 6 months after hire. This is a remote role with occasional onsite team meetings in Somerville, MA. Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $58,656.00 - $142,448.80/Annual Grade 98TEMP At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

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 care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary The UMCM will utilize clinical knowledge to analyze, assess, and render approval decisions, to determine the need for physician review as well as complete determinations following physician review. The ideal candidate will have prior authorization (outpatient review) experience in a managed care setting with Medicaid/MassHealth knowledge. Principal Duties and Responsibilities: * Expertise in clinical review for prospective, concurrent, retrospective utilization management reviews utilizing Interqual , company policies and procedures, and other resources as determined by review, including physician reviews as needed for all lines of business as per departmental needs * Review authorization requests for medical services, including making initial eligibility and coverage determinations, screening for medical necessity appropriateness, determining if additional information is required, and referral to correct programs within Mass General Brigham Health Plan as needed. * Manage incoming requests for procedures and services including patient medical records and related clinical information. * Strong working knowledge of commercial, self-insured, fully insured and limited network plans. * Adherence to program, departmental and organizational performance metrics including productivity. * Excellent verbal and written communication skills. * Excellent problem solving and customer service skills. * Would need to be available for "on call" for a minimum of once per month with the possibility of that increasing depending on staff availability; Approximately 6 months after hire. * Must be self-directed and highly motivated with an ability to multi-task. * Develop and maintain effective working relationships with internal and external customers * Hold self and others accountable to meet commitments. * Sound decision-making and time management skills. * Proactive in areas of professional development, personally and for the department. * Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise. * Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization. * Proficient with Microsoft Word, Excel, Outlook, McKesson InterQual , Outlook, SharePoint, PC based operating system, and web-based phone system. Qualifications Education * Associate's Degree Nursing required or Bachelor's Degree Nursing preferred Licenses and Credentials * Massachusetts Registered Nurse (RN) license required Experience * At least 2-3 years of utilization review experience is highly preferred * Experience using Interqual or Milliman is highly preferred * At least 1-2 years of experience in a payer setting is highly preferred * At least 1-2 years of experience in an acute care setting is highly preferred Knowledge, Skills, and Abilities * Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value * Strong aptitude for technology-based solutions. * Embrace opportunities to take the complexity out of how we work and what we deliver. * Listen to our constituents, learn, and act quickly in our ongoing pursuit of meaningful innovation * Current in healthcare trends. * Ability to inject energy, when and where it's needed. * Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback. * Be accountable for delivering high-quality work. Act with a clear sense of ownership. * Bring fresh ideas forward by actively listening to and working with employees and the people we serve. * Communicate respectfully and professionally with colleagues * Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback. Additional Job Details (if applicable) Working Conditions * Would need to be available for "on call" for a minimum of once per month with the possibility of that increasing depending on staff availability; Approximately 6 months after hire. * This is a remote role with occasional onsite team meetings in Somerville, MA. Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $58,656.00 - $142,448.80/Annual Grade 98TEMP At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus

Job Description Summary: SMOC Behavioral Healthcare is a division of SMOC that provides substance abuse and mental health outpatient services to individuals, children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. Candidates must possess at least 2-3 years' experience billing 3rd party insurance, work with Department of Public Health contracts. Why Work for SMOC? Paid Time Off: All full-time employees can accrue up to 3 weeks of vacation, and 2 weeks of sick time and are eligible for 12 paid holidays during their first year of employment. Employer-paid Life Insurance & AD&D and Long-Term Disability for full-time employees. Comprehensive Benefits Package including Medical Plans through Mass General Brigham with an HRA Employer cost-sharing program, Dental Plans with Orthodontic Coverage, and EyeMed Vision Insurance available to full-time employees. 403(B) Retirement Plan with a company match starting on day one for all full-time and part-time employees. Additional voluntary benefits including; Term and Whole Life Insurance, Accident Insurance, Critical Illness, Hospital indemnity, and Short-Term Disability. Flexible Spending Accounts, Dependent Care Accounts, Employee Assistance Program, Tuition Reimbursement and more. Primary Responsibilities: Interface with the billing subcontractor. Work hand in hand with representatives from the billing contractor and the clinic front office to make adjustments in the health record to ensure all activities are billable to all payors. Ensure all client payor information and authorizations are entered into the electronic health record. Reconcile and resolve issues related to claims submissions, research and resolve eligibility issues, including contact with clients to inform of eligibility loss. Ensure all new and ongoing prior authorizations are entered for the Outpatient Clinic programs, Residential Recovery Programs. Ensure all billing to Department of Public Health is entered accurately and in a timely fashion, for the RRS and outpatient clinic programs. Review denials and partially paid claims and resolve discrepancies. Assist in resolving overdue claim problems. Run reports and gather data as needed for financial and operating reports. Recommend write-off and process in billing system as directed. Ensure compliance with program/department, agency and/or funder requirements, as well as, SMOC policies & procedures. Other duties as assigned. Knowledge and Skill Requirements: Associates Degree preferred or relevant experience Medical and/or Mental Health third party billing experience Experience with third party billing denial and resolution process Must have ability to handle multiple and changing priorities and meet deadlines Organizational Relationship: Directly reports to Operations Director. Indirectly reports to Director of Residential Recovery Programs. Direct reports of this position are none. Physical Requirement: Ability to ascend and descend stairs Ability to see and read Ability to lift up to 10lbs Dress is business casual Working Conditions: As part of the responsibilities of this position, the Utilization Management Coordinator will have direct or incidental contact with clients served by SMOC in various programs funded or administered through the Executive Office of Health and Human Services. Remote Work Option: Remote work is permissible in some positions at SMOC depending on the key functions and responsibilities. The Compliance Officer position is eligible to work from home 0-60% of the week in scheduling coordination with the department manager. Monday through Friday: 9:00AM - 5:00PM. Includes a 1-hour unpaid lunch break. 35 Hours per week.

Department Child Development: Day Camp Employment Type Seasonal - Full Time Location Ponkapoag Workplace type Onsite Compensation $25.00 - $35.00 / hour Key Responsibilities Skills, Knowledge and Expertise Benefits About YMCA of Greater Boston The YMCA of Greater Boston is the largest social services provider in Massachusetts. Through our network of facilities and program sites, the YMCA provides health and wellness programming, child care, summer camp, youth sports, and teen leadership programs, as well as work-force development and community outreach. The YMCA of Greater Boston is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, protected genetic information, national origin, ancestry, sex, sexual orientation, gender identity, age, disability, or veteran's status.