- 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
- 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
- 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
- State of Massachusetts (Chelsea, MA)
- MVH at Chelsea is actively seeking an Admissions Nurse ( Registered Nurse III) to join their team. In this role, you will provide clinical oversight for the ... Teams * Coordinates quarterly meetings with hospice agencies to review quality of care and delivery of services *...year of full-time or equivalent part-time, experience as a registered nurse in a recognized hospital, clinic… 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
- CVS Health (MA)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- State of Massachusetts (Marlborough, MA)
- …Qualifications:_*__ * At least 3-5 years of professional work experience as a Registered Nurse working in a health care facility, preferably nursing homes. ... nursing homes, hospitals and other health care facilities, and review inspection findings. The Health Care Facility Surveyor will...years of full-time, or equivalent part-time, experience as a registered nurse in a recognized hospital, clinic… 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 (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
- 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
- Fresenius Medical Center (Lowell, 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
- Fallon Health (Worcester, MA)
- …behavioral and rehabilitative services. **Responsibilities** **Primary Job Responsibilities** ** Utilization Review and Care Coordination and Collaboration** ... discharge plan for the member to return to the community. + Conducts concurrent utilization review for members that are in the short-term custodial level of… more
- State of Massachusetts (Westborough, MA)
- …the ability to quickly learn their needs Experience conducting clinical assessments and utilization review Ability to fill out electronic surveys and assessments ... suite (Excel, Access, Word, and Microsoft project). *_Special Requirements:_* Licensed Registered Nurse /*_TO APPLY:_*/ /*__*/ Please upload both Resume… more
- Beth Israel Lahey Health (Cambridge, MA)
- …Description:** **Primary Responsibilities** (including but not limited to): 1. Performs utilization review and discharge planning to inpatient admissions to ... **Required Qualifications:** 1. Bachelor's degree preferred. Current state license as a Registered Nurse . 2. Three years of medical/surgical nursing care… more
- Fallon Health (Worcester, MA)
- …Degree in nursing, or equivalent. **License:** Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience:** Three to five years of ... expectations. Under the direction of the Director, the Appeal Nurse represents, manages and oversees second level appeal cases...agency and three to five years clinical experience in utilization review , appeals, or case management within… 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
- 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