- Beth Israel Lahey Health (Boston, MA)
- …lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...required and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse (RN), Massachusetts + Three years… more
- Beth Israel Lahey Health (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- Cognizant (Boston, MA)
- …Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work ... to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined...Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan .… more
- Commonwealth Care Alliance (Boston, MA)
- …that require intensive care management and care delivery. Within the CIC Program, the Registered Nurse (RN) serves as an integral member of an interdisciplinary ... and based on the fluctuating needs of the defined panel of members, the Registered Nurse will engage in regular assessments, visits at regularly scheduled… more
- CVS Health (Boston, MA)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Beth Israel Lahey Health (Exeter, NH)
- Registered Nurse Case Manager + Full Time + Exeter, NH 03833 ... nursing care rehab services, respiratory services, patient/family education and utilization of community resources in order to assure the...needs following the current phase of illness. **Requirements** + Registered Nurse - NH State or Compact… more
- Tufts Medicine (Lowell, MA)
- …Hospital is seeking an **ED Clinical Resource Nurse .** The ED Clinical Resource Nurse is a Registered Nurse with responsibility and accountability for ... productivity and utilization of all resources. The ED Clinical Resource Nurse utilizes the nursing process, leadership skills and current evidence based clinical… more
- Beth Israel Lahey Health (Cambridge, MA)
- …reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, interpret ... Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported...for reporting quality measures, including both concurrent medical record review and periodic medical record review for… more
- Fresenius Medical Center (Lowell, MA)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Beth Israel Lahey Health (Cambridge, MA)
- …Description:** **Primary Responsibilities** (including but not limited to): 1. Performs utilization review and discharge planning to inpatient admissions to ... **Required Qualifications:** 1. Bachelor's degree preferred. Current state license as a Registered Nurse . 2. Three years of medical/surgical nursing care… more
- CVS Health (Boston, MA)
- …inpatient, skilled nursing, or rehabilitative stay. Under the direction of a Registered /Licensed RN, the TOC Coach ensures the member experiences a seamless ... who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current...timelines. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department … more
- Lincoln Financial (Boston, MA)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... for** Education * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Molina Healthcare (Lowell, MA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary The Care Review Clinician, IP Provides support for clinical member...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- HCA Healthcare (Derry, NH)
- …+ Associate Degree in Nursing, Bachelors strongly desired, Master preferred + Active NH Registered Nurse license or compact state Registered Nurse ... supporting a balance of optimal care and appropriate resource utilization . + The RN Case Manager Team Lead will...RN Case Manager Lead opening. Our team will promptly review your application. Highly qualified candidates will be contacted… more
- Tufts Medicine (Burlington, MA)
- …**Job Description** **Minimum Qualifications:** 1. Bachelor's Degree in Nursing 2. Active Registered Nurse (RN) license in Massachusetts or compact state 3. ... (ICU, ED, Critical Care, strong Med/Surg Specialty) or equivalent case management, utilization review , denials management, or progressive leadership in an… more
- Children's Hospital Boston (Boston, MA)
- …in lab pre-analytical techniques preferred Licensure: + Current Massachusetts license as a Registered Nurse required OR + Current Massachusetts license as a ... (ASCP) Certification/Registration Required: + No certification requirement if licensed as a Registered Nurse OR + National Provider Identifier (NPI) number AND… more
- Cambridge Health Alliance (Somerville, MA)
- …Campus **Work Days:** Mon-Fri; 8:00-4:30, rotating weekends and holidays **Category:** Registered Nurse **Department:** Inpatient Case Management SH **Job ... Name:** MNA Somerville **This position in onsite in Somerville** Department Description: Utilization review (UR) in behavioral health that evaluates the medical… more