- 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 ... Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day… more
- Novo Nordisk Inc. (Boston, MA)
- …hospital faculty, medical students, residents, interns as well as attending physicians, nurse practitioners and pharmacy personnel about the use of Novo Nordisk's ... by not exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records. Qualifications Bachelor's or equivalent degree, and/or Pharm… more
- Commonwealth Care Alliance (Boston, MA)
- …for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting centralized clinical ... review and authorization creation for centrally authorized services. This...reviews). - Hire, train and mentor UM staff, including nurse reviewers and support personnel. - Act as liaison… more
- Commonwealth Care Alliance (Boston, MA)
- …discussion, and development of key performance indicator monitoring, KPI chart review and quality review processes, productivity standards. - Demonstrates ... providing team feedback based on data, key performance, and quality chart review processes. - Work cross-functionally within the organization to develop and document… more
- Monte Nido (Dedham, MA)
- …disorder treatment at Walden Behavioral Care. + Collaborate with psychiatrists, nurse practitioners, therapists, dietitians, and nursing staff to ensure holistic, ... + Conduct routine medical assessments and follow-ups, including laboratory review and medication management. + Participate in interdisciplinary team meetings… more
- Elevance Health (Woburn, MA)
- ** Nurse Reviewer I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... rotating weekends.** **New Grads are encouraged to apply!** The ** Nurse Reviewer I** will be responsible for...that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or… more
- Evolent (Boston, MA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks ... cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… more
- Children's Hospital Boston (Boston, MA)
- …Posting Title:Surgical Clinical Reviewer (20 hours/week)Department:Patient Services-Patient Care OperationsAutoReqId:82669BRStatus:Part-TimeStandard Hours per ... yours included. Position Summary / Department Summary The Surgical Clinical Reviewer collects, compiles, and submits reliable surgical data to the American… more
- Humana (Boston, MA)
- …and help us put health first** The Manager, Fraud and Waste Investigator: Nurse Audit/ Review performs clinical audit/validation processes to ensure that medical ... is complete, compliant and accurate to support optimal reimbursement. The Manager, Nurse Audit/ Review works within specific guidelines and procedures; applies… more
- Beth Israel Lahey Health (Burlington, MA)
- …necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized case managers ... necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized case managers… more
- Beth Israel Lahey Health (Cambridge, MA)
- …**Primary Responsibilities** (including but not limited to): 1. Performs utilization review and discharge planning to inpatient admissions to MAH. 2. Applies ... of care criteria and reports them to the physician reviewer . 7. Works with patients and families to facilitate...Bachelor's degree preferred. Current state license as a Registered Nurse . 2. Three years of medical/surgical nursing care experience.… more
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- …by the VHA Education Loan Repayment Services program office after review of the EDRP application.Former EDRP participants ineligible to apply. Responsibilities ... VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases,...Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion… more
- Beth Israel Lahey Health (Cambridge, MA)
- …or on-call requirements. Flexible scheduling options are available. The Oncology Nurse Navigators helps patients navigate their care and treatment, from their ... course of the treatment journey! **Job Description:** Description: The Medical Oncology Nurse Navigator is a professional registered nurse with oncology-specific… more
- Tufts Medicine (Boston, MA)
- …with the review of the Nursing Executive Council). 2. Registered Nurse (RN) license. 3. Basic Life Support (BLS) certification. **Preferred Qualifications:** 1. ... physician orders. In addition, this role focuses on performing the following Clinical Nurse duties: Assesses, plans, implements, and evaluates the care needs of a… more
- Veterans Affairs, Veterans Health Administration (Jamaica Plain, MA)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities This Registered Nurse - Assistant Nurse Manager - Urgent Care position is within the Nursing Service at the Jamaica Plain location. This is a… more
- Veterans Affairs, Veterans Health Administration (Jamaica Plain, MA)
- …and record relevant patient information. Completed work should need only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness ... information, refer to Required Documents below. This Licensed Practical Nurse position is at the VA Boston Healthcare System...completed work may require routine or detailed higher level review depending upon the complexity of the duties involved.… more
- Beth Israel Lahey Health (Needham, MA)
- …not just taking a job, you're making a difference in people's lives.** Registered Nurse or LPN / Team Nurse Float **Job Description:** **Job Summary:** Reporting ... directly to the Practice Manager and Senior Director of Nursing, the Team Nurse position is responsible for performing the duties of a RN/LPN in an outpatient… more
- State of Massachusetts (Tewksbury, MA)
- …Health, Tewksbury Hospital is seeking a highly motivated and experienced RN, Charge Nurse to work with resilient patients navigating their journey on the road to ... meetings to facilitate discharge. * Performs duties of medication and treatment nurse following pertinent policies and procedures to carry out physician's orders in… more
- State of Massachusetts (Boston, MA)
- …Carter Fuller Mental Health Center is seeking highly motivated and experienced Registered Nurse to work with resilient patients navigating their journey on the road ... issues. * Manages and supervises the nursing staff in the absence of a registered nurse of a higher grade. * Meets patient nursing care needs as charge nurse… more
- Veterans Affairs, Veterans Health Administration (Jamaica Plain, MA)
- …and record relevant patient information. Completed work should need only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness ... series. For more information, refer to Required Documents below. This Licensed Practical Nurse position is at the VA Boston Healthcare Systems located at Jamaica… more
