- Commonwealth Care Alliance (Boston, MA)
- …Abilities & Language (nice to have):** + Familiarity with care management and utilization management systems and workflows for populations with complex medical, ... performance improvement. The LTSS Program Manager reports to the Senior Director of Delegation Partnerships and Provider Engagement. The Provider Engagement team… more
- Commonwealth Care Alliance (Boston, MA)
- …compliance. The Senior Business Analyst, Clinical Operations reports to the Director , Clinical Operations Support. This role will provide significant BA support ... **Reports and Tools** + Engages with stakeholders to understand current processes/ systems and pain points as well as elicit detailed business needs… more
- Tufts Medicine (Burlington, MA)
- …Description** **Minimum Qualifications:** 1. Bachelor of Science in Nursing (BSN). 2. RN Licensure. 3. Current certification in case/ utilization management (ACM, ... MA. **About Tufts Medicine:** Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver… more
- Cognizant (Boston, MA)
- …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...submit the medical necessity determinations to the Health Plan/Medical Director based on the review of clinical documentation in… more
- Beth Israel Lahey Health (Cambridge, MA)
- …just taking a job, you're making a difference in people's lives.** Reporting to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse ... 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 clinical charts,… 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 ... PURPOSE OF POSITION: The Director of Case Management is responsible for planning,...monitoring mechanisms to identify areas for improvement of resource utilization . Plans and develops systems and processes… more
- Erickson Living (Hingham, MA)
- …Linden Ponds by Erickson Senior Living Join our team as the Assistant Director of Nursing is responsible for clinical leadership and outcomes within our Skilled, ... and dehydration. + Participating in Wound Rounds, Operations Meetings, Utilization Review, and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee. +… more
- State of Massachusetts (Westborough, MA)
- …suite (Excel, Access, Word, and Microsoft project). *_Special Requirements:_* Licensed Registered Nurse /*_TO APPLY:_*/ /*__*/ Please upload both Resume ... and Supports (OLTSS) is responsible for managing a robust system of supports for members of all ages who...year of full-time or equivalent part-time, experience as a registered nurse in a recognized hospital, clinic… more
- Beth Israel Lahey Health (Boston, MA)
- …Nursing Program required. Baccalaureate degree in Nursing strongly preferred. + License Registered Nurse required. + American Heart Association - Basic Life ... and Emergency Department. In absence of Admission Facilitator, directs bed utilization . + Provides clinical consultation, support, education and mentoring to… more
- Beth Israel Lahey Health (Charlestown, MA)
- …& Abilities:** * Must have sound understanding of ICD-10, and CPT coding systems ; prospective reimbursement system . * Ability to review and analyze issues ... **Essential Duties & Responsibilities** including but not limited to: * Maintain a system of reporting that provides timely and relevant information on all aspects… more
- Beth Israel Lahey Health (Boston, MA)
- …Schedules follow-up tests and appointments using hospital or Clinical Research Center (CRC) systems . Collaborates with RN on executing a participant's care plan. ... works under the direction of the research study investigators, study physician and/or nurse to perform clinical activities in the context of a research protocol.… more
- Beth Israel Lahey Health (Milton, MA)
- …for all. Beth Israel Milton is currently seeking a full-time Emergency Department Nurse . POSITION FUNCTION: In collaboration with the Director oversees daily ... AND RESPONSIBILITIES: . Under the general supervision of the Director supports and supervises with-in the framework of the... supports and supervises with-in the framework of the RN license, maintains the standards of practice and evaluates… more
- Commonwealth Care Alliance (Boston, MA)
- …this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. ... financial ability and forecasting for small to large Operations Management + Collaborate system and data configuration into CES (Claims Editing System ) with… more
