- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA… more
- Commonwealth Care Alliance (Boston, MA)
- …Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the… more
- Commonwealth Care Alliance (Boston, MA)
- …is responsible for providing primary care, palliative care and community intensive care management to a specific panel of high risk and complex people.? This ... Operations and in direct partnership with Care Delivery Business Ops and Clinical Management teams, the Supervisor partners in ensuring the delivery of primary care,… more
- Commonwealth Care Alliance (Boston, MA)
- …the Primary Care Nursing Manager will collaborate closely with other members of the management team. This role is full-time on site in our Boston clinic and will ... meet patient and clinic needs - Oversee clinical supply management inventory and control costs without compromising quality of... team, shared accountability for reductions in acute care utilization - Attend team meetings and huddles to provide… more
- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Commonwealth Care Alliance (Boston, MA)
- …Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the… more
- Cognizant (Boston, MA)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Lincoln Financial (Boston, MA)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... 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
- Beth Israel Lahey Health (Boston, MA)
- …and Responsibilities:** 1, Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate ... payer certification, and denied cases. 6. Monitors effectiveness/outcomes of the utilization management program, identifying and applying appropriate metrics,… more
- Beth Israel Lahey Health (Burlington, MA)
- …weekends. This position is on-site at Lahey Hospital and Medical Center. The Utilization Analyst works with physicians, the payers and inpatient case management ... medical necessity of the hospital care. Using the concepts of utilization review, clinical documentation improvement and revenue integrity, these specialized case… more
- Atrius Health (Watertown, MA)
- …package. **Job:** **Nursing* **Organization:** **Clinical Programs* **Title:** *Licensed Practical Nurse (LPN) Anticoagulation Management Service - Remote - ... care system in the country. *SUMMARY* Under the direction and supervision of a Nurse Leader or designee, this licensed practical nurse provides direct patient… more
- Fenway Health (Boston, MA)
- Registered Nurse Boston, MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing Job Type Full-time Description As a Registered Nurse ... care to individuals, families, communities, and patient populations. The Registered Nurse 's care delivery is consistent with the Massachusetts Board of Registration… 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 ... . 2. Three years of medical/surgical nursing care experience. Two years of case management or utilization management experience required. 3. Basic computer… more
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- …this occupational series. For more information, refer to Required Documents below Registered Nurse - Outpatient Home Based Primary Care position is located at the VA ... per week. Responsibilities VA offers a comprehensive total rewards package: VA Nurse Total Rewards The Home Based Primary Care (HBPC) Outpatient Staff Registered… more
- CVS Health (Boston, MA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Commonwealth Care Alliance (Boston, MA)
- …influence the clinical outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment for chronic disease management , and closing ... in primary care or care management , including: + 5+ years' experience as Registered Nurse in a high touch clinical environment or home care + AND + 2+ years… more
- Lawrence General Hospital (Lawrence, MA)
- …referrals and facilitates appropriate discharge plans. + Works in conjunction with Utilization Review Nurse , Social Worker and Clinical Care Leader to ... As the Complex Care Nurse Manager provides evidence-based assessments, tools, information, and...acute care setting with discharge planning, continuing care, care management , and utilization review. + Five years… more
- CVS Health (Boston, MA)
- …identified. - Complete inpatient confinement calls and monitoring for discharge - Management of warm transfers form concierge and engagement hub - Provides clinical ... not limited to: Coordination with -PCP and Specialty providers, Condition Management information and education, Medication management , Community Resources and… more
- Beth Israel Lahey Health (Exeter, NH)
- Registered Nurse Case Manager + Full Time + Exeter, NH 03833 ... one weekend per month (may change), alternating holiday rotation The Nurse Case Manager/Discharge Planner collaborates, facilitates and negotiates the delivery of… more
- Beth Israel Lahey Health (Cambridge, MA)
- …completed). **KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED** 1. RN with experience in risk management , quality assessment, or utilization management . 2. Strong ... to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by leading the… more
