- Milford Regional Medical Center (Milford, MA)
- …with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization management at MRMC. The UR ... year Nurse Case Management experience Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual criteria more
- Beth Israel Lahey Health (Needham, MA)
- …difference in people's lives.** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... the level of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure… more
- Lincoln Financial Group (Boston, MA)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Commonwealth Care Alliance (Boston, MA)
- …case review , workflow review and other relevant business related to utilization review process. + Works in collaboration with the UM Manager to promote ... management and leadership with the development, refinement and enhancement of utilization management workflows, policies and procedures. + Participate in… more
- Beth Israel Lahey Health (Cambridge, MA)
- …Inpatient criteria approved by the MACIPA (risk) and MAH (non-risk) Utilization Management Committees to accurately determine appropriateness for inpatient ... of care criteria and reports them to the physician reviewer . 7. Works with patients and families to facilitate...of medical/surgical nursing care experience. Two years of case management or utilization management experience… more
- Beth Israel Lahey Health (Cambridge, MA)
- …lives.** Job Description Job Description Primary Responsibilities 1. The emergency nurse initiates accurate and ongoing assessment of physical, psychological and ... focused subjective and objective data through history taking, physical examination, review of records and communication with health care providers, significant… more
- Beth Israel Lahey Health (Needham, MA)
- …requirements are met and/or exceeded. Optimal patient care and cost effective management is maintained through utilization of data and information from ... is accountable for outcomes + Maintains competency commensurate of a nurse on the unit **Organizational Management /Leadership/Communication** + Articulates and… more
- Adecco US, Inc. (Woonsocket, RI)
- …is currently assisting a National Pharmaceutical client, recruiting for a Licensed Practical Nurse to work REMOTE . The anticipated wage for this position is between ... Friday 8-4:30 CST and hours Monday-Friday 8am-8pm CST The Licensed Practical Nurse (LPN) will provide processing and communication of Commercial Prior Authorizations… more
- Commonwealth Care Alliance (Boston, MA)
- …Care Partner is primarily responsible for providing comprehensive care coordination and care management to CCA members from one or more CCA benefit programs. The ... Care Partner provides care management , and care coordination to a defined panel of...needs are consistently met + Manage panel-wide and member-specific utilization trends. + Liaise with CCA and community-based PCPs/specialists… more
- Edward M. Kennedy Community Health Center, Inc. (Milford, MA)
- …The Clinical Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to chronic disease patients, especially to those who are most at ... patients receive optimal care including acute illness and chronic disease management , education about lifestyle and behavior modification, and preventive care across… more
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …Clinical Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to Medical Assistant Treatment Program (MAT) patients. As an employer ... patients receive optimal care including acute illness and chronic disease management , education about lifestyle and behavior modification, and preventive care across… more
- WTW (Boston, MA)
- …reviewed including master templates and client specific responses + Collaborate with health management senior reviewer and Project Manager to conduct follow up ... + Health analytics experience preferred + Understanding of health plan utilization /case management processes, network management , credentialing, quality… more
- Charter Care Health Partners (Providence, RI)
- …progress of a specific patient population. Performs functions related to Patient Advocacy; Utilization Review ; Resource Management ; Continuum of Care ... preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in...experience with case management , patient navigation, case management , utilization review or discharge… more
- Brockton Hospital (Brockton, MA)
- …readmissions, improve HCAHPS, drive positive discharge outcomes and reduce LOS, and review ER utilization using proactive approaches to any barriers. The ... total medical expense of high risk/high cost patients * Providing Transitional Care Management (TCM) services for eligible patients as they transition back to the… more
- East Boston Neighborhood Health Center (East Boston, MA)
- …range planning and determining staffing needs. + Assists Home Care Manager/Residential Nurse manager to monitor utilization and processes for stocking Nursing ... in policy review and revision. Works with Home Care Director/Residential Nurse Manager to update policies, procedures and workflows as needed to ensure… more
- State of Massachusetts (Milford, MA)
- …needed with working knowledge in contract compliance, quality assurance activities, utilization review , problem identification and analysis, staffing patterns, ... quality, comprehensive Medical, Dental and Mental Health Services. Will review the quality of documentation in medical records and...REQUIREMENTS: * The applicant must be a Licensed Registered Nurse , Clinical Nurse Specialist or Nurse… more
- Amergis (South Weymouth, MA)
- …and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making ... regarding accessibility of services + Follows State/County mandated guidelines for the nurse case management programs + Participates in outreach activities to… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …strategies. Your Day to Day: + With minimal oversight, leads CMS utilization management related compliance activities including: + Identify and implement ... interpret/ draw conclusions, identify gaps/ issues & analyze information from the utilization management medical management system: Care Prominence (ie… more
- Commonwealth Care Alliance (Boston, MA)
- …improving member experience through care transitions, promoting the appropriate utilization of clincial services, and reducing unnecessary hospital admissions and ... in orienting and training new employees + Participate in case review and quality improvement projects + Maintain professional licensing, credentialing, and… more
- Beth Israel Lahey Health (Cambridge, MA)
- …of procedures, including case setup and turnaround time. 4. Consults with the nurse manager and anesthesiologist to determine the priority of on-call or urgent cases ... and collaborates with Information Systems, Patient Care Services, and Materials Management regarding integrated software programs. 15. Develops and maintains a… more