- Tufts Medicine (Burlington, MA)
- …to the utilization of resources, coordination of care across the continuum and utilization review and management . The position develops and leads the ... in Nursing (BSN). 2.Massachusetts RN Licensure. 3. Current certification in case/ utilization management (ACM, CCM, CMAC) 4. Seven (7) years of UM/Case… more
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible ... reports to the Director of Utilization Management * Oversees clinical decision review for...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for members who may ... use of the member's benefit to provide the best quality care. The TeamThe Clinical Utilization Reviewer is part of a highly dedicated and motivated team of… more
- Cognizant (Boston, MA)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Beth Israel Lahey Health (Boston, MA)
- …people's lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...required and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse ( RN ), Massachusetts +… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience… more
- Beth Israel Lahey Health (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... Analyst works with physicians, the payers and inpatient case management team to validate the medical necessity of the...necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue… more
- Robert Half Accountemps (Boston, MA)
- …They're seeking RNs to step into impactful non-clinical roles - including chart review , clinical auditing, utilization management , quality assurance, and ... Description Now Hiring Registered Nurses (RNs) - Ready for a Change...healthcare administration, or corporate healthcare roles. Requirements Featured Opportunity: RN Auditor / Clinical Reviewer + Work… more
- Beth Israel Lahey Health (Cambridge, MA)
- …SKILLS, AND ABILITIES REQUIRED** 1. RN with experience in risk management , quality assessment, or utilization management . 2. Strong spreadsheet, ... on the key performance indicators and quality measures, the RN specialist also aims to foster a culture of...reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review … more
- State of Massachusetts (Westborough, MA)
- …the ability to quickly learn their needs Experience conducting clinical assessments and utilization review Ability to fill out electronic surveys and assessments ... suite (Excel, Access, Word, and Microsoft project). *_Special Requirements:_* Licensed Registered Nurse /*_TO APPLY:_*/ /*__*/ Please upload both Resume… more
- Fallon Health (Worcester, MA)
- … Nurse in a clinical setting required. + 2 years' experience as a Utilization Management /Prior Authorization nurse in a managed care payer preferred. + ... in nursing required** **License/Certifications** + Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience** + A minimum of three… more
- Tufts Medicine (Lowell, MA)
- …needs in a timely manner + Assist with management of unit schedule + The resource RN will act as the charge nurse when assigned on the unit + Round on ... Clinical Resource Nurse .** The ED Clinical Resource Nurse is a Registered Nurse ...utilization of all resources. The ED Clinical Resource Nurse utilizes the nursing process, leadership skills and current… more
- Beth Israel Lahey Health (Cambridge, MA)
- …Description:** **Primary Responsibilities** (including but not limited to): 1. Performs utilization review and discharge planning to inpatient admissions to ... Inpatient criteria approved by the MACIPA (risk) and MAH (non-risk) Utilization Management Committees to accurately determine appropriateness for inpatient… more
- Fresenius Medical Center (Lowell, MA)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Commonwealth Care Alliance (Boston, MA)
- …require intensive care management and care delivery. Within the CIC Program, the Registered Nurse ( RN ) serves as an integral member of an ... utilization , ensuring optimal treatment for chronic disease management , and closing quality gaps. Additionally, the RN... management , including: + 5+ years' experience as Registered Nurse in a high touch clinical… more
- State of Massachusetts (Boston, MA)
- …Executive Office of Aging and Independence (AGE) is seeking a highly motivated* Registered Nurse *to join our Assisted Living Residence (ALR) Certification Unit. ... the day-to-day operation of an Assisted Living Residence. The Registered Nurse will play a vital role...and effective internal quality reviews. Additionally, the ALR Unit Nurse will review and evaluate reports with… more
- State of Massachusetts (Chelsea, MA)
- MVH at Chelsea is actively seeking an Admissions Nurse ( Registered Nurse III) to join their team. In this role, you will provide clinical oversight for the ... have at least (A) one year of full-time or equivalent part-time, experience as a registered nurse in a recognized hospital, clinic or medical facility, and (B)… more
- State of Massachusetts (Marlborough, MA)
- …Qualifications:_*__ * At least 3-5 years of professional work experience as a Registered Nurse working in a health care facility, preferably nursing homes. ... nursing homes, hospitals and other health care facilities, and review inspection findings. The Health Care Facility Surveyor will...years of full-time, or equivalent part-time, experience as a registered nurse in a recognized hospital, clinic… more
- Beth Israel Lahey Health (Needham, MA)
- …practice model. **Job Description:** **Essential Responsibilities:** 1. Performs utilization management , care coordination, and discharge planning ... third weekend & rotating holiday required) Job Summary: The RN Case Manager (CM) facilitates the coordination of care.... 4. Knowledge of discharge planning practices, understanding of utilization review practices including third party payer… more