- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) ... timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring… more
- Beth Israel Lahey Health (Plymouth, MA)
- …the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… 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 ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Fresenius Medical Center (Lowell, MA)
- …supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve ... of maximum quality care to all patients. + Must complete Clinical Manager training modules and ongoing developmental programs within the specified time line.… 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
- Baystate Health (Springfield, MA)
- …a Magnet Hospital for Nursing Excellence is looking for a medical telemetry inpatient Registered Nurse to join our team in Springfield, MA. At Baystate Health, ... **Certifications:** Basic Life Support - American Heart AssociationAmerican Heart Association, Registered Nurse - State of MassachusettsState of Massachusetts… more
- Baystate Health (Springfield, MA)
- …(BMC), a Magnet Hospital for Nursing Excellence is looking for a medical inpatient Registered Nurse to join our team in Springfield, MA. At Baystate Health, ... **Certifications:** Basic Life Support - American Heart AssociationAmerican Heart Association, Registered Nurse - State of MassachusettsState of Massachusetts… more
- Beth Israel Lahey Health (Cambridge, MA)
- …to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by leading the ... reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts,...If you're unable to resolve a situation, find a manager who can. **9. Protect confidentiality and privacy:** It's… more
- Fallon Health (Worcester, MA)
- …field preferred. **License/Certification** + License: Active, unrestricted license as a Registered Nurse in Massachusetts + Certification: Certification in Case ... Twitter and LinkedIn. **Brief summary of purpose:** The Custodial Nurse Case Manager (NCM) is a key...**Experience** + 3+ years of clinical experience as a Registered Nurse managing chronically ill members or… more
- Beth Israel Lahey Health (Cambridge, MA)
- …**Required Qualifications:** 1. Bachelor's degree preferred. Current state license as a Registered Nurse . 2. Three years of medical/surgical nursing care ... care teaching hospital affiliated with Harvard Medical School. The Inpatient Case Manager (CM) performs utilization reviews and coordinates discharge planning… 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**...is vital. Care management program metrics including, emergency room utilization , and hospital admission/readmission data will be reviewed on… more
- BAYADA Home Health Care (Canton, MA)
- …in Senior Living communities **_._** Are you a solutions-oriented, team-focused ** Registered Nurse or Therapist (Physical Therapist, Physical Therapist ... inspire professional growth. **Qualifications:** + Current MA licensure as a Registered Nurse , Physical Therapist, Physical Therapy Assistant, Occupational… 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
- CenterWell (Boston, MA)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent ... skills to make an impact** **Required Qualifications** + Licensed Registered Compact Nurse license (RN) with no...volume and fast paced environment + Previous experience in utilization management + Education: BSN or Bachelor's degree in… 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 ... summer and one winter holiday. **Job Description:** The Emergency Department Case Manager is responsible and accountable for patient trajectory by assisting the… more
- Baystate Health (Springfield, MA)
- …to this role. **Education:** Bachelors Degree in Nursing (Required) **Certifications:** Registered Nurse - State of MassachusettsState of Massachusetts **Equal ... **RN, Patient Placement Bed Manager - Per Diem** **Evenings and Nights 8 or...identify level of care, potential need for practice guideline utilization , to determine the anticipated LOS and anticipated care… more
- CenterWell (Fall River, MA)
- …+ Graduate of an accredited School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's license, auto insurance ... our** Fall River, MA **branch location.** The **RN Clinical Manager ** coordinates and oversees all direct care patient services...and reliable transportation. + Two years as a Registered Nurse with at least one-year of… more
- Baystate Health (Springfield, MA)
- + **Per Diem Hospital Case Manager ** The **RN Hospital Case Manager ** is a registered nurse responsible for the coordination of clinical care, quality, ... of a designated population of patients. The Hospital Case Manager is responsible for overseeing an efficient plan that...for transitions + Leads the team to ensure appropriate utilization of patient resources and directs care to other… more
- Cambridge Health Alliance (Somerville, MA)
- …Campus **Work Days:** Mon-Fri; 8:00-4:30, rotating weekends and holidays **Category:** Registered Nurse **Department:** Inpatient Case Management SH **Job ... RN Case Manager - Inpatient Case Management SH **Requisition Number:**...Somerville **This position in onsite in Somerville** Department Description: Utilization review (UR) in behavioral health that evaluates the… more
- Point32Health (MA)
- …Qualifications - what you need to perform the job Certification and Licensure + Registered Nurse with current unrestricted license in state of residence + May ... wellness interventions, and disease/chronic condition management per department guidelines. The nurse care manager possesses strong clinical knowledge, critical… more