UM Project Manager in Boston, MA at Beacon Health Options

Date Posted: 7/28/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic Utilization Project Manager to join our Utilization Management team at our office in Boston, MA!  The UM Project Manager is responsible for assisting the VP of Utilization Management in coordinating cross departmentally the overall Utilization Management activities at MBHP for inpatient, outpatient, diversionary, and emergency services. 

The incumbent is responsible to support the coordination and functional integration of the “macro” facility based utilization management program and the “micro” individual utilization management program.   Assist the AVP in the implementation of utilization management goals, education, and the training of clinical and regional staff regarding UM functions. In addition, serve as project manager for special projects such as the yearly revision of the utilization management plan, IRR surveys, revision of medical necessity criteria and other clinical/quality related projects and documents.

Position Responsibilities:

  • Under the direction of the AVP of Utilization Management support the implementation of a multi-pronged, UM plan designed to improve quality, support recovery principles, contain costs while ensuring appropriate, medical necessary utilization of services.
  • Facilitate inter-departmental communication regarding UM activities.
  • Maintain shared documents for program tracking and inter-departmental communication.   
  • Assist in coordinating the overall Utilization Management activities cross departmentally. Assist in coordinating and functionally integrating the facility based utilization management program, intensive case-by-case utilization management of outlier facilities and providers, and the individual case management program. 
  • Participate in training activities for clinical, medical and network management staff on UM policies and procedures, NCQA requirements, and data systems including but not limited to COGNOS, OPPA, SAPPA dashboards.
  • Act as the primary contact for the Integrated Regional teams to develop, implement, and monitor corrective action plans in conjunction with recommendation of the AVP of Utilization Management.  
  • Organize and document training activities such as  the annual IRR and monthly CEU programs

Position Requirements:

  • Education:  Master’s degree in social work, psychology, mental health, nursing, or other related field required preferred, Bachelor’s degree required
  • Relevant Work Experience: Managed care and behavioral health experience preferred

To Apply:

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Beacon Health Options company is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled