- 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
- Teleflex (Boston, MA)
- …territory. The incumbent is responsible for the growth of overall product utilization within their accounts; including, but not limited to, selling the designated ... gain new business. - Facilitate sales growth by conducting physician, nurse , and technologist training and account in-servicing of Interventional Capital products.… 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
- 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
- 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
- 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 ... health and welfare benefit package. **Job:** **Nursing* **Organization:** **Cardiology* **Title:** * Registered Nurse (MNA) Cardiology - Kenmore - Full time… more
- Massachusetts Institute of Technology (Cambridge, MA)
- Registered Nurse , Care Coordinator + Job Number: 25320 + Functional Area: Health Care + Department: MIT Health + School Area: Executive Vice President + Pay ... + Schedule: + Pay Grade: 9 Email a Friend Save Save Apply Now Posting Description REGISTERED NURSE , CARE COORDINATOR, MIT Health, will serve as a core member of… more
- Beth Israel Lahey Health (Cambridge, MA)
- …reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, interpret ... Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported...for reporting quality measures, including both concurrent medical record review and periodic medical record review for… more
- Baystate Health (Springfield, MA)
- …- Maximum $96,137.00 - $110,510.00 - $130,728.00 The Hospital Case Manager is a registered nurse responsible for the coordination of clinical care, quality, and ... and Competencies:** + Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by third party payers… more
- Tufts Medicine (Melrose, MA)
- …role is essential in developing and maintaining an infrastructure for the systematic review and management of complex patients. The position will work closely with ... managers, TMIN Practice Optimization Coaches (POMs) and primary care providers to review patient records, analyze data, and identify practice and patient outlier … more
- Fresenius Medical Center (Fairhaven, MA)
- …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
- CVS Health (Boston, MA)
- …through integration. - Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit plan eligibility and ... business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management Certification **Education** Associate Degree… more
- North Shore Community Health (Gloucester, MA)
- …The Primary Care Team Nurse Care Manager (PC team RN CM) is a registered nurse whose primary responsibility is managing a panel of patients on an assigned ... PC team RN CM coordinates the overall health care utilization for NSCH's most vulnerable patients. The Organization North...Perform nurse visits independently and within the registered nurse scope of practice outlined by… more
- Baystate Health (Springfield, MA)
- …- American Heart AssociationAmerican Heart Association, Driver License - OtherOther, Registered Nurse - State of MassachusettsState of Massachusetts **Equal ... - Maximum $87,859.00 - $100,984.00 - $119,412.00 **RN, ACO Nurse Care Manager, Community Health Center** The **ACO ...room, or from a skilled nursing facility. Responsible to review the discharge summaries, follow up on testing that… more
- Beth Israel Lahey Health (Cambridge, MA)
- …Qualifications:** 1. Bachelor's degree preferred. 2. Current Massachusetts state license as a Registered Nurse (RN). 3. Two years of recent acute hospital ... with Harvard Medical School. The Inpatient Case Manager (CM) performs utilization reviews and coordinates discharge planning for MAH inpatient admissions. Inpatient… 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 (Burlington, MA)
- …**Essential Duties & Responsibilities including but not limited to:** 1) Performs utilization review and discharge planning to inpatient admissions. 2) Applies ... to meet the needs of the department. **Minimum Qualifications:** Education: * Registered Nurse , Bachelors Degree or commensurate experience preferred. Licensure,… 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
- CenterWell (Pittsfield, MA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
