- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is ... and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets… more
- Commonwealth Care Alliance (Boston, MA)
- …is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA)...reviews). - Hire, train and mentor UM staff, including nurse reviewers and support personnel. - Act as liaison… more
- Commonwealth Care Alliance (Boston, MA)
- …None Desired Licensing (nice to have): - Medical Assistant or Licensed Practical Nurse - Coding Certification Required Experience (must have): - 3-5 years of ... - Ability to teach, mentor, and coach - Able to support teams with utilization of telehealth technologies (video, chat, etc.) to support CCA members and enable… more
- Commonwealth Care Alliance (Boston, MA)
- …a member of the management team, shared accountability for reductions in acute care utilization - Attend team meetings and huddles to provide input on patient care, ... have): - Meaningful clinical experience including: - 3+ years' experience as a Registered Nurse in a high-touch clinical environment or home care, OR - 2+ years… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Beth Israel Lahey Health (Plymouth, MA)
- …years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the ... severity of an array illnesses, intensity of service, and care coordination needs + Ability to identify appropriateness of patients admission and level of care needs (inpatient & observation) utilizing Interqual criteria + Knowledge of Interqual required;… more
- 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 status ... of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for… 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 in ... to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical… more
- Beth Israel Lahey Health (Plymouth, MA)
- …years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the ... severity of an array illnesses, intensity of service, and care coordination needs + Ability to identify appropriateness of patients admission and level of care needs (inpatient & observation) utilizing Interqual criteria + Knowledged of Interqual required;… more
- Commonwealth Care Alliance (Boston, MA)
- …is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA)...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… 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 ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...Education * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state… 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)
- …with Harvard Medical School. The Inpatient Case Manager (CM) performs utilization reviews and coordinates discharge planning for MAH inpatient admissions. Inpatient ... Description:** **Primary Responsibilities** (including but not limited to): 1. Performs utilization review and discharge planning to inpatient admissions to MAH. 2.… more
- CVS Health (Boston, MA)
- …AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support ... **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in...lower levels of care. + 1+ years' experience in Utilization Review. + CCM and/or other URAC recognized accreditation… more
- Commonwealth Care Alliance (Boston, MA)
- …intensive care management and care delivery. Within the CIC Program, the Registered Nurse (RN) serves as an integral member of an interdisciplinary team for medical ... on the fluctuating needs of the defined panel of members, the Registered Nurse will engage in regular assessments, visits at regularly scheduled intervals, and… more
- Atrius Health (Braintree, MA)
- …value-based care system in the country. *_SUMMARY_*__ Physician Assistant/ Nurse Practitioner (MNA) position supporting our Orthopedics department. The Physician ... Assistant/ Nurse Practitioner will work collaboratively on a team to...care in Specialty. Demonstrated excellence in practice, documentation and utilization . Maintain high patient satisfaction. Ability to work effectively… more
- Brockton Hospital (Brockton, MA)
- Registered Nurse (RN), Part-Time Flex Nights, Emergency Signature Healthcare's Brockton Hospital is hiring a Part-Time Flex Overnights Registered Nurse (RN) for ... commitment to comprehensive patient care. Under the guidance of a Charge nurse , our team emphasizes efficient throughput, flexibility, and autonomy in initiating… more
- Atrius Health (Braintree, MA)
- …the direction of the department chief, the incumbent is a certified nurse practitioner (NP) who possesses advanced training/skills in assessing, diagnosing, and ... Serves as a patient educator in areas of specialization. *_EDUCATION/LICENSES/CERTIFICATIONS_* * Nurse Practitioner (NP) *- Must be nationally certified as an FNP… more
- CVS Health (Boston, MA)
- …compliance driven timelines. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department Utilization and ... Excel, and Outlook - Active and unrestricted Licensed Practical Nurse (LPN) in MA and NJ - Hospice/ palliative...High School Diploma or equivalent GED plus Licensed Practical Nurse **Anticipated Weekly Hours** 40 **Time Type** Full time… more
- Brockton Hospital (Brockton, MA)
- Registered Nurse (RN), Part-Time Flex, 12-hour Day Shift, A5 Medical-Surgical Unit Signature Healthcare's Brockton Hospital is hiring for a Part-Time Flex, 12-Hour ... Day Shift, Registered Nurse (RN) for the A5 Medical-Surgical Unit in Brockton,...+ Research: uses clinical inquiry in practice + Resource Utilization : considers factors related to safety, effectiveness and cost… more
