- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is ... responsible for day-to-day timely clinical and service authorization review for medical necessity and...service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key… more
- Commonwealth Care Alliance (Boston, MA)
- …have): - Meaningful clinical experience including: - 3+ years' experience as a Registered Nurse in a high-touch clinical environment or home care, OR ... on site in our Boston clinic and will assume the primary responsibility for clinical operations. If you enjoy working with a collaborative team, striving for the… more
- Cognizant (Boston, MA)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Beth Israel Lahey Health (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review, clinical documentation improvement and revenue integrity, these specialized ... the medical necessity of the hospital care. Using the concepts of utilization review, clinical documentation improvement and revenue integrity, these specialized… more
- CVS Health (Boston, MA)
- …Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization . **Required Qualifications** + Registered Nurse (RN) ... CVS Health Aetna has an opportunity for a full-time Utilization Management (UM) Nurse Consultant. As a...Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills… more
- CVS Health (Boston, MA)
- …shift times are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence required. + Minimum ... solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team.… more
- Commonwealth Care Alliance (Boston, MA)
- …in primary care or care management, including: + 5+ years' experience as Registered Nurse in a high touch clinical environment or home care + AND + 2+ ... management and care delivery. Within the CIC Program, the Registered Nurse (RN) serves as an integral...and social needs. The RN uses evidenced-based care approaches, clinical skills, education, and training to influence the … 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 ... and efficient care to individuals, families, communities, and patient populations. The Registered Nurse 's care delivery is consistent with the Massachusetts… more
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- …to this occupational series. For more information, refer to Required Documents below Registered Nurse - Outpatient Home Based Primary Care position is located at ... Nurse Total Rewards The Home Based Primary Care (HBPC) Outpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based care to… 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 ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Tufts Medicine (Boston, MA)
- …with physician orders. In addition, this role focuses on performing the following Clinical Nurse duties: Assesses, plans, implements, and evaluates the care ... group of patients or provides nursing care and identified clinical support tasks within the scope of practice for...in Nursing. 2. Basic Life Support (BLS) Certification. 3. Registered Nurse (RN) License. 4. Three (3)… more
- Atrius Health (Concord, MA)
- …Department Chief, Nurse Leader or designee, this registered professional nurse provides practice support to a clinical team, recognizing the patient as ... and welfare benefit package. **Job:** **Nursing* **Organization:** **Internal Medicine* **Title:** * Registered Nurse (MNA) Internal Medicine - Concord - Full… more
- Atrius Health (Dedham, MA)
- …Department Chief, Nurse Leader or designee, this registered professional nurse provides practice support to a clinical team, recognizing the patient as ... and welfare benefit package. **Job:** **Nursing* **Organization:** **Internal Medicine* **Title:** * Registered Nurse (MNA) Internal Medicine - Dedham - Full… more
- Atrius Health (Dedham, MA)
- …Department Chief, Nurse Leader or designee, this registered professional nurse provides practice support to a clinical team, recognizing the patient as ... and welfare benefit package. **Job:** **Nursing* **Organization:** **Internal Medicine* **Title:** * Registered Nurse (MNA) Internal Medicine - Dedham - 40HRS*… more
- Atrius Health (Boston, MA)
- …Department Chief, Nurse Leader or designee, this registered professional nurse provides practice support to a clinical team, recognizing the patient as ... health and welfare benefit package. **Job:** **Nursing* **Organization:** **Endocrinology* **Title:** * Registered Nurse (MNA) Endocrinology - Kenmore - Part time… more
- Atrius Health (Boston, MA)
- …Department Chief, Nurse Leader or designee, this registered professional nurse provides practice support to a clinical team, recognizing the patient as ... health and welfare benefit package. **Job:** **Nursing* **Organization:** **Nephrology* **Title:** * Registered Nurse (MNA) Nephrology - Kenmore - Per diem*… more
- Beth Israel Lahey Health (Cambridge, MA)
- …high reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, ... Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported...outliers, compiling reports and serving as the liaison with clinical stakeholder and clinical committees in sharing… more
- CVS Health (Boston, MA)
- …Service/Health Services (as applicable to hiring program) or Associates degree with a Registered Nurse with Behavioral Health experience/ background with 3 years ... we do it all with heart, each and every day. **Position Summary** Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization… more
- Evolent (Boston, MA)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
- Beth Israel Lahey Health (Cambridge, MA)
- …**Required Qualifications:** 1. Bachelor's degree preferred. Current state license as a Registered Nurse . 2. Three years of medical/surgical nursing care ... with Harvard Medical School. The Inpatient Case Manager (CM) performs utilization reviews and coordinates discharge planning for MAH inpatient admissions. Inpatient… more
