- Commonwealth Care Alliance (Boston, MA)
- …for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is responsible… more
- Novo Nordisk Inc. (Boston, MA)
- …sales volume Utilize discretionary budget for maximum impact on sales Clinical Understanding Deep understanding of cardiometabolic disease state and patient ... Inform health system decision makers, influencers and stakeholders hospital faculty, medical students, residents, interns as well as attending physicians, nurse… more
- Fresenius Medical Center (Lowell, MA)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Dana-Farber Cancer Institute (Boston, MA)
- …for a non-oncology area, eg infection control) and the process of conducting medical clinical research. In addition, the CRN utilizes evidence-based nursing ... The Research Nurse in collaboration with the physician, is responsible...physician, is responsible for the implementation and evaluation of clinical research in their specific program/area. The CRN has… more
- Elevance Health (Woburn, MA)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Clinical Fraud Investigator II** is responsible… more
- Humana (Boston, MA)
- …Manager, Fraud and Waste Investigator: Nurse Audit/ Review performs clinical audit/validation processes to ensure that medical record documentation and ... approach, resources, schedules and goals. The Manager, Fraud and Waste Investigator: Nurse Audit/ Review validates and interprets medical documentation to… more
- BAYADA Home Health Care (Wilmington, MA)
- …DCO to ensure cohesive and consistent management of all field staff. + Review all clinical documentation to ensure consistent, accurate, high-quality services. + ... BAYADA Home Health Care is seeking a Registered Nurse (RN) to fill the position of **Home...holidays, vacation and sick leave. + Vision, dental and medical health plans. + Employer paid life insurance, 401k… more
- Beth Israel Lahey Health (Burlington, MA)
- … necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized case ... of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity,...staff on best practices to ensure reimbursement based on medical care provided. 11. Maintains and reports clinical… more
- HCA Healthcare (Derry, NH)
- …for some benefits may vary by location._** **Job Summary and Qualifications** The HCA Nurse Residency Program at Parkland Medical Center provides you with the ... join an organization that invests in you?_ **At** **Parkland Medical Center** **, you come first!** HCA Healthcare is...growth and development of our future nurses! The **HCA Nurse Residency Program** is a year-long program designed to… more
- HCA Healthcare (Derry, NH)
- …personal growth, we encourage you to apply for our PRN Registered Nurse Medical Surgical RN opening. We review all applications. Qualified candidates will be ... have the PRN career opportunities as a(an) PRN Registered Nurse Medical Surgical RN you want with...values to ensure an outstanding patient experience and positive clinical outcomes. What you will do in this role:… more
- Tufts Medicine (Boston, MA)
- …practice and/or best practices. The professional registered nurse at Tufts Medical Center provides clinical excellence, which fosters and supports an ... In addition, this role focuses on performing the following Clinical Nurse duties: Assesses, plans, implements, and...review of the Nursing Executive Council). 2. Registered Nurse (RN) license. 3. Basic Life Support (BLS) certification.… more
- Beth Israel Lahey Health (Cambridge, MA)
- …reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, interpret data, and implement ... Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported...state and federal regulators, insurance appeals, internal correspondence, and clinical summaries for medical peer review… more
- HCA Healthcare (Derry, NH)
- …path, we encourage you to apply for our PRN Medical Surgical Registered Nurse RN opening. We review all applications. Qualified candidates will be contacted ... Do you have the career opportunities as a(an) PRN Medical Surgical Registered Nurse RN you want...values to ensure an outstanding patient experience and positive clinical outcomes. What you will do in this role:… more
- Dana-Farber Cancer Institute (Boston, MA)
- …modify nursing assignments, as needed, to meet the needs of patients. The Nurse Manager provides clinical leadership and management and promotes professional ... inquiry, facilitation of learning and advocacy for patients and staff. The Nurse Manager collaborates with the Clinical Specialist to provide clinical… more
- Dartmouth Health (Hampstead, NH)
- …fathering all necessary demographic and clinical information needed to present to medical staff and/or review team. * Verbally present all active referrals ... Overview In coordination with of the Director of Admissions, review referrals for psychiatric and medical appropriateness for acute inpatient psychiatric… more
- Beth Israel Lahey Health (Watertown, MA)
- …care or family medicine practice and serves as a clinical resource for the medical practice. The Team Nurse provides high quality, direct patient care in a ... delegation of clinical and administrative functions as appropriate to the Medical Assistant (MA) staff. Responsible for educating and training our MA team and… more
- Commonwealth Care Alliance (Boston, MA)
- … experience in primary care or care management, including: + 5+ years' experience as Registered Nurse in a high touch clinical environment or home care + AND + ... CCA's patients incorporates the care of individuals with significant medical , behavioral, and social complexities that require intensive care...and care delivery. Within the CIC Program, the Registered Nurse (RN) serves as an integral member of an… more
- Tufts Medicine (Lowell, MA)
- …healthcare. Ready to grow with us? Tufts Medicine Lowell General Hospital is seeking an **ED Clinical Resource Nurse .** The ED Clinical Resource Nurse is ... for optimal efficiency, productivity and utilization of all resources. The ED Clinical Resource Nurse utilizes the nursing process, leadership skills and… more
- State of Massachusetts (Danvers, MA)
- …high risk due to complex medical needs. Acts as a liaison to medical and clinical professionals in the community, area hospitals and Rehab Centers. ... RN IV Nurse Supervisor Duties and Responsibilities 1. Provides on-site clinical and administrative oversight, support, and supervision to the nursing staff and… more
- Humana (Boston, MA)
- …in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The Nurse reviews the medical documentation, researching claims, ... and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to...Medical Directors on submitted G&A cases. The G&A Nurse will participate in initiatives which result in improved… more
