- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer is...**What You'll Be Doing:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- 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
- Point32Health (Canton, MA)
- …leading, and modifying the business processes and operations for all levels of utilization management review (ie, Precertification and Intake Services, ... Point32Health business rules; oversight of all aspects of outpatient services utilization management ; and development, implementation and refinement of effective… more
- Beth Israel Lahey Health (Cambridge, MA)
- …a job, you're making a difference in people's lives.** Registered Nurse - Emergency Department **Job Description:** **Primary Responsibilities** 1. The emergency ... nurse initiates accurate and ongoing assessment of physical, psychological...subjective and objective data through history taking, physical examination, review of records and communication with health care providers,… more
- Elevance Health (Smithfield, RI)
- …**How you will make an impact:** + Develops, maintains, and enhances the claims review process. + Assists management with developing unit goals, policies, and ... Nurse Audit Lead - Carelon Payment Integrity **Location:**...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by healthcare providers through prepayment… more
- Prime Therapeutics (Boston, MA)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… more
- Cambridge Health Alliance (Cambridge, MA)
- …team leader in multi-disciplinary team discussion regarding treatment planning, treatment review , quality assurance and utilization review ... Nurse Practitioner - Clinical Specialist II (APRN), Psychiatry...to nursing policy and procedure. + Communicate effectively with management , peers, and health team members. + Interact effectively… 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
- Fresenius Medical Center (Medford, MA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Brockton Hospital (Brockton, MA)
- … management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience ... delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare… more
- Sedgwick (Boston, MA)
- …and consult review ; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review . **Skills & ... Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical… 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
- 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
- Amergis (Southborough, 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
- Tufts Medicine (Boston, MA)
- …(2) years of experience in a clinical setting (nursing unit, care management , physician's office) **Preferred Qualifications** **:** 1. College Degree. 2. Medical ... hospital discharges. 2. Reviews, authorizes, and assigns referral request submitted for review . 3. Provides hospital admission report review and production of… more
- Harvard University (Cambridge, MA)
- …clinical management , supervision, quality assurance, continuous improvement, utilization management , and understanding complex organizational, financial, and ... students from other cultures; student health issues; urgent care and crisis management ; outreach and consultation in a university setting; treatment of clients with… more
- Harvard University (Cambridge, MA)
- …quality projects, daily huddles, Lean activities, and other continuing education, utilization management , and other departmental activities. + Fosters positive ... sponsorship. + This position has a 90-day orientation and review period. Department:Urgent CarePre-Employment Screening:Criminal, Education, IdentitySchedule: Schedule Week… more