- US Tech Solutions (Canton, MA)
- …required. Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that is expected to function independently in her / ... all aspects of clinical decision making and support needed to perform utilization management , medical necessity determinations and benefit determinations using… more
- Healthcare Staffing Plus (Boston, MA)
- The registered nurse , adheres to the rules and regulations of the Massachusetts Board of Registration in Nursing. is primarily responsible for professional ... and their families across the health care continuum. The registered nurse is accountable for clinical, educational,...recommended script in the patient medical record for provider review and approval. Schedule appointments for the primary care… more
- South Shore Health (Weymouth, MA)
- …chart at time of occurrence as well as notifying the appropriate staff member, ie, nurse , physician. 3 - Safe utilization of gas cylinders and piped in gas ... order before treatment administered as evidenced by Process Improvement review . b - Discontinues treatment if any adverse or...the use of mechanical ventilation protocols for both ventilator management and weaning evaluations. e - Upon the order… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities… 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 ... reports to the Director of Utilization Management * Oversees clinical decision review for...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- 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 ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The Role The RN Utilization Management Reviewer is responsible for facilitating care ... to provide the best quality care. The Team The RN Utilization Management Reviewer...against a license must be disclosed and reviewed + Registered nurses only, bachelor's degree in nursing (BSN) preferred… more
- Children's Hospital Boston (Boston, MA)
- 80451BRJob Posting Title:Per Diem RN Case Manager, Utilization Management /ReviewDepartment:Patient Services-Patient Care ... Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current...preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse ( RN ) + A… more
- Commonwealth Care Alliance (Boston, MA)
- …local regulatory guidelines. + Serve as the lead for CCA's Utilization Review functions working closely with other medical management team members. + Support ... case review findings, actions, and outcomes in accordance with Utilization + Management policies; meets health plan inter-rater reliability guidelines… more
- Beth Israel Lahey Health (Burlington, MA)
- …in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse ( RN ) Case ... a timely process. Registered Nurses (RNs) with utilization review experience, case management ...the needs of the department. **Minimum Qualifications:** Education: * Registered Nurse , Bachelors Degree or commensurate experience… more
- US Tech Solutions (Canton, MA)
- …required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that is expected to function independently in her / ... of clinical decision making and support needed to perform utilization management , medical necessity determinations and benefit...the job** + Bachelor's degree in Nursing, preferred + Registered Nurse with current a and unrestricted… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …TeamAs an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a liaison and business expert for member and ... your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound...provider submitted appeals. Working collaboratively with Physician review unit, Utilization Management ,… more
- Highmark Health (Boston, MA)
- …Highmark Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... + Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN … more
- Highmark Health (Boston, MA)
- …Highmark Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Molina Healthcare (Boston, MA)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... identifying opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational… more
- Actalent (Boston, MA)
- …policies and standards. Essential Skills + Proficiency in clinical review , case management , utilization review , and utilization management . ... Clinical Review Clinician Job Description As a Clinical ...Medicare, and Medicaid regulations is preferred. + Familiarity with utilization management processes is preferred. + State… more
- Tufts Medicine (Burlington, MA)
- …in cooperation with multiple revenue cycle and hospital departments, such as Coding, Utilization Management (UM), Case Management , Quality and Physician ... organize, implement, and evaluate the CDI program. This includes management of case mix index (CMI), length of stay...**Minimum Qualifications:** 1. BSN degree 2. Licensed as a Registered Nurse 3. Five (5) years relevant… more
- WTW (Boston, MA)
- …Third Party Administrator, Regulatory Agency, Legal/Compliance Firm, or insurance company + US Registered Nurse or LCSW with active licensed preferred + Health ... reviewed including master templates and client specific responses + Collaborate with health management senior reviewer and Project Manager to conduct follow up… more
- Erickson Living (Hingham, MA)
- …clinical leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management /Safety ... and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice....care, assisted living or hospital) is required. + Current Registered Nurse license for the state in… more
