- CenterWell (Providence, RI)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent ... your skills to make an impact** **Required Qualifications** + Licensed Registered Compact Nurse license (RN) with no disciplinary action and ability to obtain non… more
- Molina Healthcare (Norfolk, MA)
- …Job Summary The Care Review Clinician, IP Provides support for clinical member services review assessment processes. Responsible for verifying that services ... are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members...a candidate with a MA RN licensure. Candidates with UM Medical Review background and experience using MCG or… more
- Fallon Health (Worcester, MA)
- …of clinical criteria and medical necessity determinations. The Appeal Nurse is responsible for ensuring compliance with all applicable state and federal ... the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge,… more