- 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 ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- Beth Israel Lahey Health (Boston, MA)
- …lives.** Position Summary: 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 ...required and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse (RN), Massachusetts + Three years… 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 ... the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized… more
- Cognizant (Boston, MA)
- …Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work ... to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined...Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan .… more
- CVS Health (Boston, MA)
- …shift times are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence required. + Minimum ... high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… 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 ... Teams * Coordinates quarterly meetings with hospice agencies to review quality of care and delivery of services *...year of full-time or equivalent part-time, experience as a registered nurse in a recognized hospital, clinic… more
- Commonwealth Care Alliance (Boston, MA)
- …that require intensive care management and care delivery. Within the CIC Program, the Registered Nurse (RN) serves as an integral member of an interdisciplinary ... and based on the fluctuating needs of the defined panel of members, the Registered Nurse will engage in regular assessments, visits at regularly scheduled… more
- CVS Health (Boston, MA)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… 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 (Cambridge, MA)
- …reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, interpret ... Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported...for reporting quality measures, including both concurrent medical record review and periodic medical record review for… more
- Robert Half Accountemps (Boston, MA)
- …seeking RNs to step into impactful non-clinical roles - including chart review , clinical auditing, utilization management, quality assurance, and case ... Description Now Hiring Registered Nurses (RNs) - Ready for a Change from Primary Care? Opportunities Across Massachusetts | Travel, Contract, & Permanent Roles… 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
- 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 ... **Required Qualifications:** 1. Bachelor's degree preferred. Current state license as a Registered Nurse . 2. Three years of medical/surgical nursing care… more
- Fallon Health (Worcester, MA)
- …Degree in nursing, or equivalent. **License:** Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience:** Three to five years of ... expectations. Under the direction of the Director, the Appeal Nurse represents, manages and oversees second level appeal cases...agency and three to five years clinical experience in utilization review , appeals, or case management within… more
- Sharecare (Boston, MA)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
- CVS Health (Boston, MA)
- …inpatient, skilled nursing, or rehabilitative stay. Under the direction of a Registered /Licensed RN, the TOC Coach ensures the member experiences a seamless ... who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current...timelines. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department … more
- Lincoln Financial (Boston, MA)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... for** Education * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Molina Healthcare (Boston, MA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary The Care Review Clinician, IP Provides support for clinical member...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- Brockton Hospital (Brockton, MA)
- …delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare ... primary responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It… more
- Fallon Health (Worcester, MA)
- …in nursing required** **License/Certifications** + Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience** + A minimum of three ... Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review ...to five years clinical experience as a Registered Nurse in a clinical setting required.… more
