- Beth Israel Lahey Health (Plymouth, MA)
- …using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- Amergis (Canton, MA)
- Salary: $3595 / Week Amergis Healthcare is seeking an experienced Registered Nurse and self-motivated individual to provide data collection and related ... activities for Quality Improvement (QI) and Utilization Review as well as completion of...care, billing, and reimbursement processes. For this role, the nurse will be adding Admissions and Insurance Authorizations. MUST… more
- Children's Hospital Boston (Boston, MA)
- …Utilization Management) preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse (RN) + A certification as a Certified Case ... 80451BRJob Posting Title:Per Diem RN Case Manager, Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard Hours per Week:1… 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
- 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
- Sharecare (Boston, MA)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and… more
- Fresenius Medical Center (Lincoln, RI)
- …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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- … Units to assist with medical necessity determinations. Key Qualifications: + Registered Nurse with an active unrestricted professional Massachusetts Nursing ... customers, relaying decisions accurately and thoroughly. Education and Experience: + Registered Nurse with an active Massachusetts Nursing license required… more
- Brockton Hospital (Brockton, MA)
- …delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare ... primary responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It… more
- Beth Israel Lahey Health (Plymouth, MA)
- …job that may reasonably be required._ **Education/Experience Required:** _Required_ + State of MA Registered Nurse (RN) + 3-5 years acute care nursing + Two ... 3) Decreasing unit cost, 4) reducing readmissions. **Duties/Responsibilities:** **A. Utilization Management** Performs review of anticipated admissions utilizing… more
- Molina Healthcare (Boston, MA)
- …identifying opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational ... performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity,... Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of RN license.… more
- Children's Hospital Boston (Boston, MA)
- … review process for acute psychiatric care + Possessing experience in Utilization Management/ Utilization Review + Demonstrating the ability to integrate ... Utilization Management) preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse (RN) + A certification as a Certified Case… more
- Highmark Health (Boston, MA)
- …+ Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse (RN) license + Delaware RN license must be ... Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health… 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
- Dana-Farber Cancer Institute (Brookline, MA)
- …+ 1 year clinical and/or related experience required. + Case Management, Utilization Review , Oncology, Cellular Therapy and/or Prior Authorization experience is ... Effector Cell (IEC) therapies, including benefit verification, pre-certification, concurrent review , appeals, and preparation of cost estimates for insurance...preferred. + Licensed as a Registered Nurse in the Commonwealth of Massachusetts… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …+ 1 year of clinical and/or related experience required. Case Management, Utilization Review and/or Prior Authorization experience is preferred. + ... **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. **KNOWLEDGE, SKILLS, AND ABILITIES… more