- Commonwealth Care Alliance (Boston, MA)
- …for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is responsible… more
- Novo Nordisk Inc. (Boston, MA)
- …sales volume Utilize discretionary budget for maximum impact on sales Clinical Understanding Deep understanding of cardiometabolic disease state and patient ... Inform health system decision makers, influencers and stakeholders hospital faculty, medical students, residents, interns as well as attending physicians, nurse… more
- Monte Nido (Dedham, MA)
- …to electrolyte imbalances, malnutrition, and refeeding syndrome. + Conduct routine medical assessments and follow-ups, including laboratory review and medication ... Dedham, MA, location. This physician will play a crucial role in the medical management of patients with eating disorders and co-occurring medical conditions.… more
- Dana-Farber Cancer Institute (Boston, MA)
- …for a non-oncology area, eg infection control) and the process of conducting medical clinical research. In addition, the CRN utilizes evidence-based nursing ... The Research Nurse in collaboration with the physician, is responsible...physician, is responsible for the implementation and evaluation of clinical research in their specific program/area. The CRN has… more
- Elevance Health (Woburn, MA)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Clinical Fraud Investigator II** is responsible… more
- Humana (Boston, MA)
- …Manager, Fraud and Waste Investigator: Nurse Audit/ Review performs clinical audit/validation processes to ensure that medical record documentation and ... approach, resources, schedules and goals. The Manager, Fraud and Waste Investigator: Nurse Audit/ Review validates and interprets medical documentation to… more
- BAYADA Home Health Care (Wilmington, MA)
- …DCO to ensure cohesive and consistent management of all field staff. + Review all clinical documentation to ensure consistent, accurate, high-quality services. + ... BAYADA Home Health Care is seeking a Registered Nurse (RN) to fill the position of **Home...holidays, vacation and sick leave. + Vision, dental and medical health plans. + Employer paid life insurance, 401k… 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 ... of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity,...staff on best practices to ensure reimbursement based on medical care provided. 11. Maintains and reports clinical… more
- Tufts Medicine (Boston, MA)
- …practice and/or best practices. The professional registered nurse at Tufts Medical Center provides clinical excellence, which fosters and supports an ... In addition, this role focuses on performing the following Clinical Nurse duties: Assesses, plans, implements, and...review of the Nursing Executive Council). 2. Registered Nurse (RN) license. 3. Basic Life Support (BLS) certification.… more
- Beth Israel Lahey Health (Cambridge, MA)
- …reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, interpret data, and implement ... Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported...state and federal regulators, insurance appeals, internal correspondence, and clinical summaries for medical peer review… more
- Dana-Farber Cancer Institute (Boston, MA)
- …modify nursing assignments, as needed, to meet the needs of patients. The Nurse Manager provides clinical leadership and management and promotes professional ... inquiry, facilitation of learning and advocacy for patients and staff. The Nurse Manager collaborates with the Clinical Specialist to provide clinical… more
- Fresenius Medical Center (Roxbury, MA)
- …12 weeks of paid & structured training with an assigned Preceptor & Nurse Educator** + 70,000+ dedicated employees, 200,000+ patients, 2,600+ dialysis centers, 350+ ... of the hemodialysis health care team as a Registered Nurse Applicant under the direction or supervision of a...transcribes and enters physician lab orders accurately into the Medical Information System. + Ensures appropriate preparation of lab… more
- Beth Israel Lahey Health (Needham, MA)
- …Educator Team Nurse will perform all of the duties of a Team Nurse , including: a. Coordinate and facilitate quality clinical management of a broad based ... Nursing Students. Provides on-going education and training to practice staff. Updates clinical knowledge and skills though consultation, review of literature and… more
- Beth Israel Lahey Health (Jamaica Plain, MA)
- …care or family medicine practice and serves as a clinical resource for the medical practice. The Team Nurse provides high quality, direct patient care in a ... delegation of clinical and administrative functions as appropriate to the Medical Assistant (MA) staff. Responsible for educating and training our MA team and… more
- Beth Israel Lahey Health (Watertown, MA)
- …care or family medicine practice and serves as a clinical resource for the medical practice. The Team Nurse provides high quality, direct patient care in a ... delegation of clinical and administrative functions as appropriate to the Medical Assistant (MA) staff. Responsible for educating and training our MA team and… more
- Commonwealth Care Alliance (Boston, MA)
- … experience in primary care or care management, including: + 5+ years' experience as Registered Nurse in a high touch clinical environment or home care + AND + ... CCA's patients incorporates the care of individuals with significant medical , behavioral, and social complexities that require intensive care...and care delivery. Within the CIC Program, the Registered Nurse (RN) serves as an integral member of an… more
- Humana (Boston, MA)
- …in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The Nurse reviews the medical documentation, researching claims, ... and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to...Medical Directors on submitted G&A cases. The G&A Nurse will participate in initiatives which result in improved… more
- Dana-Farber Cancer Institute (Boston, MA)
- The staff nurse 's responsibilities include assessment, planning, implementation and evaluation of nursing care for a complex patient population. The infusion ... nurse provides patient and family education and psychosocial and...own professional goals and learning needs. The role requires clinical expertise, critical thinking, collaborative practice, excellent communication skills… more
- Tufts Medicine (Stoneham, MA)
- …with physician orders. In addition, this role focuses on performing the following Clinical Nurse duties: Assesses, plans, implements, and evaluates the care ... group of patients or provides nursing care and identified clinical support tasks within the scope of practice for...Bachelor's degree in Nursing (BSN). Associates degree considered with review of Nurse Executive Council. 2. Registered… more
- Humana (Boston, MA)
- …community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Behavioral Health Nurse 2 completes medical record reviews from medical … more
