- Beth Israel Lahey Health (Burlington, MA)
- …difference in people's lives.** 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 ...and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse (RN), Massachusetts + Three years of recent clinical… more
- Beth Israel Lahey Health (Burlington, MA)
- …you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered ... Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality assurance for Lahey… more
- Highmark Health (Boston, MA)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Lincoln Financial (Boston, MA)
- …Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like to work here?** At ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Fresenius Medical Center (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 loss review . + Responsible for all required network reporting and on-… more
- Brockton Hospital (Brockton, MA)
- …patient flow and reduce service delays through problem resolution and follow-up. Monitors on- site case managers and utilization review staff to ensure ... management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience required.… more
- CenterWell (Marlborough, MA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- Baystate Health (Springfield, MA)
- …appropriate management as outlined in the evidence based practice guidelines Uses Utilization Analysis /Management principles, insures that patient's site of ... strongly preferred + Requires a working knowledge of community resources and Utilization /Quality Review standards. + Understanding of the hospitals patient… more
- East Boston Neighborhood Health Center (East Boston, MA)
- …range planning and determining staffing needs. + Assists Home Care Manager/Residential Nurse manager to monitor utilization and processes for stocking Nursing ... in policy review and revision. Works with Home Care Director/Residential Nurse Manager to update policies, procedures and workflows as needed to ensure… more
- Fresenius Medical Center (Waltham, MA)
- …accurate. Oversees and monitors payer contracting functions for all Access Site locations. Oversees and monitors intake process including patient registration and ... insurance verification for all Access Site locations. **PRINCIPAL DUTIES AND RESPONSIBILITIES** : + Reimbursement + Monitors the day to day functions of the Patient… more
- Highmark Health (Boston, MA)
- …regulatory requirements. Document, process and route requests for services to the nurse reviewer and other departments based on documentation procedures, including ... review type, clinical information, and decision timeframes. Follow policies...and notification requirements are met + Communicate effectively with Utilization Management Staff, providers, other internal and external customers… more