- Milford Regional Medical Center (Milford, MA)
- …with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization management at MRMC. The UR ... year Nurse Case Management experience Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual criteria more
- Lincoln Financial Group (Boston, MA)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Beth Israel Lahey Health (Burlington, MA)
- …Medical Center is now offering up to a $3,500 in signing bonuses for our Utilization Review positions. Important Details: * Signing Bonuses are paid out in three ... Description:** **Job Description:** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate… more
- Beth Israel Lahey Health (Burlington, MA)
- …40 **Work Shift:** Day (United States of America) Joint role of Case Manager and Utilization Review Nurse Hospital at Home Full Time Days 8:00am-4:30pm ... and holiday rotations required **Job Description:** The Inpatient Registered Nurse (RN) Case Manager for Hospital at Home Care...to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management … more
- Elevance Health (Woburn, MA)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Baystate Health (Springfield, MA)
- …support to the patient's primary care team regarding patients' utilization management needs. The Clinical Utilization Reviewer -LPN is responsible ... **Position** Licensed Practical Nurse **SCHEDULE:** + Full time + Monday -...experience in home care and/or 2 years' experience in utilization management Certifications: + . Basic Life… more
- Baystate Health (Greenfield, MA)
- … Management experience **Preferred Work Experience:** **1)** Experience in utilization review process **Skills and Competencies:** **1)** Ability to ... directed to: **Cole Courtemanche, Healthcare Recruiter** **###@baystatehealth.org** **Summary:** The Utilization Management Specialist (UMS)/Hospital Case Manager (HCM)… more
- Beth Israel Lahey Health (Cambridge, MA)
- …lives.** Job Description Job Description Primary Responsibilities 1. The emergency nurse initiates accurate and ongoing assessment of physical, psychological and ... focused subjective and objective data through history taking, physical examination, review of records and communication with health care providers, significant… more
- Elevance Health (Woburn, MA)
- …**How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and ... ** Nurse Audit Lead** **Supports the Carelon Payment Integrity...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
- Veterans Affairs, Veterans Health Administration (Leeds, MA)
- …after complete review of the EDRP application. Responsibilities This Registered Nurse (Acute Mental Health) position is located in the Nursing Services at the ... nurse independently provides patient-centered and recovery-oriented care, milieu management , and maintains self-awareness while caring for patients living with… more
- Beth Israel Lahey Health (Needham, MA)
- …requirements are met and/or exceeded. Optimal patient care and cost effective management is maintained through utilization of data and information from ... is accountable for outcomes + Maintains competency commensurate of a nurse on the unit **Organizational Management /Leadership/Communication** + Articulates and… more
- Beth Israel Lahey Health (Wakefield, MA)
- …system considered in lieu of degree + Active, unrestricted Massachusetts Registered Nurse License required. Certification in Case Management (CCM) preferred. NH ... of population health and is responsible to ensure that quality, efficient care management services are provided to the BILHPN provider's risk populations. The Care… more
- Fallon Health (Springfield, MA)
- …oriented, person-centered care, disease progression, disease prevention, wellness and management of chronic and episodic illness consistent with the participant's ... to Summit ElderCare program participants focusing on disease prevention, wellness and management of chronic and episodic illness. Addresses advance directives in a… more
- Commonwealth Care Alliance (Springfield, MA)
- …Care Partner is primarily responsible for providing comprehensive care coordination and care management to CCA members from one or more CCA benefit programs. The ... Care Partner provides care management , and care coordination to a defined panel of...needs are consistently met + Manage panel-wide and member-specific utilization trends. + Liaise with CCA and community-based PCPs/specialists… more
- Edward M. Kennedy Community Health Center, Inc. (Milford, MA)
- …The Clinical Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to chronic disease patients, especially to those who are most at ... patients receive optimal care including acute illness and chronic disease management , education about lifestyle and behavior modification, and preventive care across… more
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …Clinical Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to Medical Assistant Treatment Program (MAT) patients. As an employer ... patients receive optimal care including acute illness and chronic disease management , education about lifestyle and behavior modification, and preventive care across… more
- Trinity Health (Springfield, MA)
- …ACM Certification preferred. **Preferred Skills:** + **Experience:** 3-5 years in Case Management , Utilization review , or similar experience preferred. ... to ensure seamless communication and coordination of care. + **Resource Management ** : Optimizing the use of resources, including medical equipment, personnel,… more
- Trinity Health (Springfield, MA)
- …of Science in Nursing BSN degree preferred. + **Experience:** 3-5 years in Case Management , Utilization review , or similar experience preferred. Hospital or ... program. BSN graduate preferred. + **Licensure** : Current Licensure as a Registered Nurse RN in Massachusetts. + **Certification** : BLS (AHA/ARC). CCM or ACM… more
- Fresenius Medical Center (West Springfield, 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
- Beth Israel Lahey Health (Beverly, MA)
- …care givers, and families. Their functions include concurrent and retrospective review to assure appropriate utilization , assessment, prevention of denials ... 1. Current Massachusetts RN licensure 2. Certification in Case Management preferred **Patient Age Served: Provides direct patient care to:**… more