- Milford Regional Medical Center (Milford, MA)
- …services to our community with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization ... 1 year Nurse Case Management experience Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual criteria more
- 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)
- …a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in ... Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality assurance for Lahey… more
- Evolent (Boston, MA)
- …Stay for the culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We ... better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer, Nurse , you will routinely interact with leadership and management...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- …after complete review of the EDRP application. Responsibilities The Registered Nurse position is located in Nursing, Mental Health at the Bedford campus. This ... at 40 hours per week. VA offers a comprehensive total rewards package: VA Nurse Total Rewards The Inpatient Mental Health (MH) Registered Nurse (RN) provides… more
- Cambridge Health Alliance (Cambridge, MA)
- …team leader in multi-disciplinary team discussion regarding treatment planning, treatment review , quality assurance and utilization review ... Nurse Practitioner - Clinical Specialist II (APRN), Psychiatry...authorizing practice in an expanded role as a Psychiatric Nurse Clinical Specialist and authorization including prescriptive authority. _In… 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
- 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
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …engagement in self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and provides ongoing ... point-of-care testing, treatments, and lab and diagnostic test result review + Provides timely and informed patient triage +...shifts on a rotating basis. Required Qualifications: + Registered Nurse License in MA + Bachelor's degree in Nursing… more
- Beth Israel Lahey Health (Boston, MA)
- …or lack thereof, current trends and analyze reports. * Provides data for the Utilization Review Committee. 7. Fiscal: Under the direction of the Service Line ... time, 40 hours per week. Job Profile Summary Provides assessment, screening and ongoing review of the clinical course to all patients who are referred to the case… 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 ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's… more
- Covenant Health (Nashua, NH)
- …attended /documented. + Annual goals are achieved. + Attends pertinent case management/ utilization review programs to maintain current knowledge of UR practices. ... communication. + Supports the role of the clinical primary nurse and utilizes their clinical expertise and input in...medical necessity (whether based on initial or continuing stay review ) to determine whether a level of care change… more
- Beth Israel Lahey Health (Burlington, MA)
- …and in conjunction with the appropriate clinical personnel, (ie department nurse manager or clinical manager), coordinates and manages the procurement of ... the Supply Chain Coordinator will assure supply availability and efficient utilization of supply resources. Essential Duties & Responsibilities including but not… more
- Fallon Health (Worcester, MA)
- …and Post-Acute authorization request data and disseminates information to the Utilization Nurses for review . Additionally, supports the authorization process ... for maternity, acute, subacute and discharge planning requests for all Utilization Management requests * Upload clinical to correct authorization, archive to… 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
- Fresenius Medical Center (Waltham, MA)
- …guidelines as mandated by Medicare. + Assures the correct setup and utilization of billing software (Advantx/Medical Manager) and maintains system security and ... include; + Front Desk Coordinator, expectations established and controls set. + Nurse Manager, assuring proper chart documentation is established. + Physician, … more
- Tufts Medicine (Burlington, MA)
- …with multiple revenue cycle and hospital departments, such as Coding, Utilization Management (UM), Case Management, Quality and Physician advisors and leaders. ... **Job Description** **Minimum Qualifications:** 1. BSN degree 2. Licensed as a Registered Nurse 3. Five (5) years relevant experience in the management of Clinical… more
- WTW (Boston, MA)
- …issues or impact to timeline proactively to Project Manager + Complete initial review of carrier responses for parity projects + Map carrier responses to appropriate ... a manner consistent with WTW work processes and peer review standards (eg, filing of drafts, deliverables, client and...Agency, Legal/Compliance Firm, or insurance company + US Registered Nurse or LCSW with active licensed preferred + Health… more
- Dana-Farber Cancer Institute (Boston, MA)
- …practitioner group consisting of physicians, physician's assistants, program nurses and nurse practitioners and other care providers, the individuals in this ... the assigned patient population to achieve patient safety, flow and resource utilization goals of the organization and sponsoring agencies; + Responsible for… more
- Evolent (Boston, MA)
- …years of direct clinical patient care + **Minimum one year of experience with Utilization Review (UM) in a managed care environment** + **Cardiology and Oncology ... + Performs other duties as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of three… more