- 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 ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...required and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse (RN), Massachusetts + Three years… more
- 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
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- Cognizant (Boston, MA)
- …Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work ... to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined...Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan .… more
- State of Massachusetts (Boston, MA)
- …Executive Office of Aging and Independence (AGE) is seeking a highly motivated* Registered Nurse *to join our Assisted Living Residence (ALR) Certification Unit. ... the day-to-day operation of an Assisted Living Residence. The Registered Nurse will play a vital role...and effective internal quality reviews. Additionally, the ALR Unit Nurse will review and evaluate reports with… more
- Commonwealth Care Alliance (Boston, MA)
- …that require intensive care management and care delivery. Within the CIC Program, the Registered Nurse (RN) serves as an integral member of an interdisciplinary ... and based on the fluctuating needs of the defined panel of members, the Registered Nurse will engage in regular assessments, visits at regularly scheduled… more
- Atrius Health (Boston, MA)
- …Under the direction of the Department Chief Physician and Nursing Supervisor, this Registered Nurse position is responsible for effective care delivery and ... or other dimensions of diversity. **Job:** **Nursing* **Organization:** **Cardiology* **Title:** * Registered Nurse (MNA) Cardiology - Kenmore - Full time… more
- Robert Half Accountemps (Boston, MA)
- …seeking RNs to step into impactful non-clinical roles - including chart review , clinical auditing, utilization management, quality assurance, and case ... Description Now Hiring Registered Nurses (RNs) - Ready for a Change from Primary Care? Opportunities Across Massachusetts | Travel, Contract, & Permanent Roles… more
- Sharecare (Boston, MA)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
- Molina Healthcare (Plymouth, MA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary The Care Review Clinician, IP Provides support for clinical member...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… 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
- 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
- Brockton Hospital (Brockton, MA)
- …preferred. Must have current license from Commonwealth of Massachusetts to practice as a Registered Nurse . Minimum of five years clinical experience in an acute ... care facility required. Prior experience in case management, utilization review or discharge planning required. more
- Tufts Medicine (Boston, MA)
- …of physicians, mid-level practitioners, and may work under the direction of registered nurses depending on their unit. A clinical technologist role that has ... providers who are absent, etc.) by making continual adjustments in room utilization and assignment. 2. Prepares medical record for patient visit, confirming accuracy… more