- 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)
- …people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse (RN) Case Manager for ... Clinic inpatient admissions. Leads the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case… more
- Amergis (Canton, MA)
- Salary: $3595 / Week Amergis Healthcare is seeking an experienced Registered Nurse and self-motivated individual to provide data collection and related ... activities for Quality Improvement (QI) and Utilization Review as well as completion of...care, billing, and reimbursement processes. For this role, the nurse will be adding Admissions and Insurance Authorizations. MUST… more
- Children's Hospital Boston (Boston, MA)
- …Utilization Management) preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse (RN) + A certification as a Certified Case ... 80451BRJob Posting Title:Per Diem RN Case Manager, Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard Hours per Week:1… more
- Beth Israel Lahey Health (Burlington, MA)
- …collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities ... Duties & Responsibilities** _including but not limited to:_ + Ensures that Utilization Review nurses are consistently recommending the appropriate admission… more
- Humana (Boston, MA)
- …**Use your skills to make an impact** **Required Qualifications** + Active Licensed Registered Nurse (RN) in the state of Virginia or obtain a ... community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care...experience a plus + Previous Occupational and Physical Therapy utilization review + Previous experience in … more
- Tufts Medicine (Lowell, MA)
- …Hospital is seeking an **ED Clinical Resource Nurse .** The ED Clinical Resource Nurse is a Registered Nurse with responsibility and accountability for ... productivity and utilization of all resources. The ED Clinical Resource Nurse utilizes the nursing process, leadership skills and current evidence based clinical… more
- Beth Israel Lahey Health (Wakefield, MA)
- …care system considered in lieu of degree + Active, unrestricted Massachusetts Registered Nurse License required. Certification in Case Management (CCM) ... Working with the healthcare team, the Care Manager, RN monitors appropriate utilization of healthcare resources, promotes quality and efficiency by developing and… more
- Fresenius Medical Center (Northampton, MA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- … Units to assist with medical necessity determinations. Key Qualifications: + Registered Nurse with an active unrestricted professional Massachusetts Nursing ... customers, relaying decisions accurately and thoroughly. Education and Experience: + Registered Nurse with an active Massachusetts Nursing license required… more
- Baystate Health (Springfield, MA)
- …Degree in Nursing (Required) **Certifications:** EFM or Inpatient Obstetrics - NCC, Registered Nurse - State of Massachusetts **Equal Employment Opportunity ... **Summary:** The Perinatal Safety Nurse is a member of Obstetric Nursing Leadership...nursing/provider leadership, Performance Improvement Coordinator, and Risk Management. Additionally, review adverse events and be a member of OB… 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
- Baystate Health (Springfield, MA)
- …- American Heart AssociationAmerican Heart Association, Driver License - OtherOther, Registered Nurse - State of MassachusettsState of Massachusetts **Equal ... **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
- Humana (Boston, MA)
- …We are not able to hire candidates that are currently living in Puerto Rico. + Registered Nurse with current in-state RN license + At least 3 years of varied ... or comparable (such as Interqual, etc.) **Preferred Qualifications** + Utilization Review /Quality Management experience + BA/BSN degree **Work-At-Home… more
- …and advising subordinates as necessary. Resolving routine personnel problems. Authorize and review utilization of home health nursing, social work, occupational, ... - OtherOther, Occupational Therapist - OtherOther, Physical Therapist - OtherOther, Registered Nurse - State of MassachusettsState of Massachusetts **Equal… more
- Baystate Health (Springfield, MA)
- …American Heart AssociationAmerican Heart Association, Certification in Specialty - OtherOther, Registered Nurse - State of MassachusettsState of Massachusetts ... Center (BMC), a Magnet Hospital for Nursing Excellence is looking for a** ** Nurse Educator** **to join our** **Neonatal Intensive Care unit and Critical Care… more
- Beth Israel Lahey Health (Wakefield, MA)
- …care system considered in lieu of degree. + Active, unrestricted Massachusetts Registered Nurse License required. Certification in Case Management (CCM) ... Working with the healthcare team, the Care Manager, RN monitors appropriate utilization of healthcare resources, promotes quality and efficiency by developing and… 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
- Molina Healthcare (Worcester, MA)
- …identifying opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational ... performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity,... Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of RN license.… more