- Lincoln Financial Group (Boston, MA)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... 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
- State of Massachusetts (Fall River, MA)
- …center is seeking dedicated and compassionate individuals for the position of Registered Nurse IV who desire a rewarding career making a difference in the lives ... patient teaching in regard to health and wellness, medication and illness management . The selected candidate will possess strong interpersonal skills to encourage… more
- Beth Israel Lahey Health (Needham, MA)
- …requirements are met and/or exceeded. Optimal patient care and cost effective management is maintained through utilization of data and information from ... is accountable for outcomes + Maintains competency commensurate of a nurse on the unit **Organizational Management /Leadership/Communication** + Articulates and… more
- Humana (Boston, MA)
- …MS Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review /Quality Management experience + BA/BSN degree + ... of our caring community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following… more
- Commonwealth Care Alliance (Boston, MA)
- …Care Partner is primarily responsible for providing comprehensive care coordination and care management to CCA members from one or more CCA benefit programs. The ... Care Partner provides care management , and care coordination to a defined panel of...needs are consistently met + Manage panel-wide and member-specific utilization trends. + Liaise with CCA and community-based PCPs/specialists… more
- Brockton Hospital (Brockton, MA)
- …readmissions, improve HCAHPS, drive positive discharge outcomes and reduce LOS, and review ER utilization using proactive approaches to any barriers. The ... total medical expense of high risk/high cost patients * Providing Transitional Care Management (TCM) services for eligible patients as they transition back to the… more
- East Boston Neighborhood Health Center (East Boston, MA)
- …range planning and determining staffing needs. + Assists Home Care Manager/Residential Nurse manager to monitor utilization and processes for stocking Nursing ... in policy review and revision. Works with Home Care Director/Residential Nurse Manager to update policies, procedures and workflows as needed to ensure… more
- Amergis (South Weymouth, MA)
- …and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making ... regarding accessibility of services + Follows State/County mandated guidelines for the nurse case management programs + Participates in outreach activities to… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …strategies. Your Day to Day: + With minimal oversight, leads CMS utilization management related compliance activities including: + Identify and implement ... interpret/ draw conclusions, identify gaps/ issues & analyze information from the utilization management medical management system: Care Prominence (ie… more
- Commonwealth Care Alliance (Boston, MA)
- …improving member experience through care transitions, promoting the appropriate utilization of clincial services, and reducing unnecessary hospital admissions and ... in orienting and training new employees + Participate in case review and quality improvement projects + Maintain professional licensing, credentialing, and… more
- Brockton Hospital (Brockton, MA)
- …of five years clinical experience in an acute care facility required. Prior experience in case management , utilization review or discharge planning required. ... Provides medical-surgical pediatric and obstetrical case management services to Brockton Hospital patients. Responsible for assuring continuity of care for patients… more