942 Case Manager Sr jobs in Massachusetts

Registered Nurse
Currently licensed in good standing to practice as a Registered Nurse in the State of Massachusetts.
Graduate from an accredited School of Nursing
Must have no less than six months experience in acute care setting as an RN prior to home care assignment, or experience as required by state regulations.
Minimum of one year's experience as an RN required.
Transports self to patient's home/facility in a reliable vehicle and has a valid Massachusetts driver's license.
May be working in multiple locations in a workday.
Must pass Occupational Health Clearance

Cambridge Health Alliance

Boston, MA 02118

BNY

Boston, MA 02203

Bachelor's degree in Business, Finance, Technology, or related field.
5+ years of project management experience, preferably in financial services or consulting.
2+ years proven experience as Agile Lead, Release Train Engineer, or similar role.
Deep understanding of Deal Management processes and Commercial Controls (KYC/AML, OREs, etc.).

Tenet Massachusetts

Cherry Valley, MA 01611

UnitedHealth Group

Boston, MA 02112

Registered Nurse (RN) with a current, active, unrestricted RN License in Massachusetts
Currently have OR be able to obtain an RAC/CT MDS certification (must have completed certification prior to start date)
4+ years of nursing experience, specifically in long-term care and/or medical record review with knowledge of Medicare and Medicaid
Recent long-term care MMQ, MDS, staff development or management experience (in long-term care)
Experience working within medical insurance and/or healthcare industries
Experience analyzing inventory, researching, identifying, and resolving issues
Experience with defining and managing processes within a team
Experience trouble shooting issues for users within teams, IT, and/or business partners
Proven knowledge of healthcare insurance industry (Medicaid, Medicare, CMS)
Demonstrated knowledge of process flow of UM, including prior authorization, concurrent authorization, and/or clinical appeal and guidance reviews
Must live in the Boston MA Regional Area to conduct daily travel requirements
Ability to travel within geographic territory (state of Massachusetts) at least 90% of the time (some weeks will require 100% travel as business needs dictate) and assist when needed throughout the state of Massachusetts for audits. (Audits will be conducted onsite)
Must have reliable transportation and be able to provide proof of a valid, unrestricted Driver's License and current Auto Insurance