01/11 | BEACON HEALTH STRATEGIES The Clinical Manager is responsible for overseeing and monitoring the day-to-day workflow of the UR and CM functions on site. The Clinical Manager will be a resource person to team members and Plan case managers, providing support and assistance in application of Beacon’s level of care criteria, scheduling, answering questions about policies and procedures and being availa | | Boston, MA | | map | | | action |
02/05 | Job Description: As the Database Administrator (DBA), this individual will be responsible for closely working with application development and business intelligence teams to enhance the performance and functionality of existing databases and systems. The DBA will also participate in the design and delivery of new database solutions in our development, test, and production environments. Primary res | | Woburn, MA | | map | | | action |
02/05 | JOB DESCRIPTION: Responsible for triaging and managing of members referred to ICC who may be high risk, high utilizing, at significant clinical risk or under-utilizing services. Provide oversight to CBHI network providers. 50% of work can be home based. PRIMARY RESPONSIBILITIES 1. Manage ICC Members referred by CBHI providers 2. Managing, coordinating care, tracking and reporting of all assigned I | | Boston, MA | | map | | | action |
02/05 | JOB SUMMARY: The Medical Director charged with the oversight of all utilization and case management activities for Beacon Health Strategies, LLC, pursuant to the Boston Medical Center Healthnet Plan contract. The Medical Director works closely with the Beacon Medical Affairs Department to support and implement the necessary structures and processes to meet URAC and NCQA MBHO standards, and to esta | | Boston, MA | | map | | | action |
02/05 | JOB SUMMARY: Authorizes and reviews utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings; assists with discharge planning and ambulatory follow up activity; Maintains phone coverage for Clinical Referral line on ACD system; provides member assistance with mental health and substance abuse issues, and participates in special util | | Boston, MA | | map | | | action |
02/05 | JOB DESCRIPTION: The Provider Data Specialist is primarily responsible for updating and maintaining the provider database in FlexCare with meticulous attention to detail. In addition, the Provider Data Specialist will be responsible for completing specified assignments that assist the department in meeting contractual goals, and interfacing with providers through the Provider Services Line. PRIMAR | | Woburn, MA | | map | | | action |
02/05 | JOB DESCRIPTION: The Quality Analyst works with the Quality Department and Beacon staff on quality improvement activities, analysis, and reporting of key quality indicators. PRIMARY RESPONSIBILITIES 1. Research, reporting, and data analysis focusing on NCQA and URAC accreditation activities (e.g. Demographic Analysis of Service Utilization Patterns, Trend Reports as assigned). 2. Annual member sat | | Woburn, MA | | map | | | action |
02/05 | Oversee the weekly functions of the Psychotropic Drug Intervention Program (PDIP), to ensure that members and providers are appropriately identified and receive interventions in a timely manner. This is one of the agency’s fast paced core programs. Previous program management, operations, and analytical experience required. Supervisory experience required. PRIMARY RESPONSIBILITIES PDIP: Coordinati | | Woburn, MA | | map | | | action |
01/29 | The Claims Manager is responsible for the management of the claims daily functions and direct supervision of the claim processors and claim specialists in Beacon’s claims department. The Manager oversees all claims entry and claims telephone line inquiries handled by the claims staff. The role is primarily responsible for reporting internally and externally to clients on volumes, productivity, adj | | Woburn, MA, 0180... | | map | | | action |
01/20 | Intensive Case Manager Responsible for triaging and managing of members referred to Case Management. Responsible for the tracking and managing of members identified as Intensive Case Management (ICM) who may be high risk, high utilizing, at significant clinical risk or under-utilizing services. PRIMARY RESPONSIBILITIES 1. Identification of all assigned ICM Members 2. Managing, coordinating care, t | | Boston, MA, 0180... | | map | | | action |
01/20 | Credentialing Specialist JOB DESCRIPTION: This position’s main function is to credential and re-credential behavioral health providers in Beacon’s network spanning multiple states and regions. The position will perform specified assignments relating to ensuring that processes and protocols are in place to ensure all credentialing file accuracy according to contractual and NCQA standards. PRIMARY R | | Woburn, MA | | map | | | action |
01/19 | Oversee the clinical operations of the Psychotropic Drug Intervention Program (PDIP), to ensure that members and providers are appropriately identified and receive interventions in a timely manner. Responsible for the clinical functions / requirements of other pharmacy programs such as the High Risk Children Pharmacy program in Massachusetts. PRIMARY RESPONSIBILITIES Weekly program responsibilitie | | Woburn, MA | | map | | | action |
01/19 | JOB DESCRIPTION: The Appeals Coordinator is responsible for the processing, tracking and follow up of all medical necessity and administrative denials and appeals. This individual is required to have excellent communication and organizational skills, the ability to work cooperatively with health plan Appeal Divisions, the ability to provide excellent customer service to providers and members, and t | | Woburn, MA | | map | | | action |
01/12 | Clinical Manager The Clinical Manager is responsible for overseeing and monitoring the day-to-day workflow of the UR and CM functions. The Clinical Manager will be a resource person to team members and health plan case managers, providing support and assistance in application of Beacon’s level of care criteria, scheduling, answering questions about policies and procedures and being available to ha | | Woburn, MA, 0180... | | map | | | action |
01/11 | Provider Relations Representative The Provider Relations Representative serves as Beacon’s representative to the provider community in the assigned markets/ regions. Provider Relations Representatives assist is managing Beacon’s behavioral health provider network, including administrative issue resolution, provider event planning and participation, network access monitoring, and recruitment. Repre | | Woburn, MA, 0180... | | map | | | action |