- CVS Health (Woonsocket, RI)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- CenterWell (Providence, RI)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Providence, RI)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Woonsocket, RI)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Brockton Hospital (Brockton, MA)
- Registered Nurse (RN), Part- Time Flex Nights, A2-Telemetry Signature Healthcare's Brockton Hospital is hiring for a Part Time Flex Registered Nurse (RN) for ... rounds encompassing nursing, hospitalists, social work, physical therapy, and case management , we strategize patient discharge plans. The unit handles a spectrum… more
- Dana-Farber Cancer Institute (Attleboro, MA)
- …the highest quality patient experience while maximizing provider time and space utilization . The Nurse Director uses extensive theoretical, evidence-based, and ... for the planning, implementation and evaluation of clinical operations and personnel management of the assigned patient care unit. He/she acts as a liaison… more
- Evolent (Providence, RI)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Brockton Hospital (Brockton, MA)
- Registered Nurse (RN), Part-Time, Flex, Nights, 8 Hour Shift, Telemetry Signature Healthcare's Brockton Hospital is hiring for a Part-Time, Flex, 8 Hour Shift, ... Registered Nurse (RN) for Telemetry in Brockton, MA. Type: Part-Time,...nursing, the hospitalist team, social work, physical therapy, case management to plan for patient discharge. The majority of… more
- Fresenius Medical Center (Providence, RI)
- …procedure, under the direction of the Facility Manager and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in optimum ... acting on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other FVC administrative and… more
- Fresenius Medical Center (Fairhaven, 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
- Brockton Hospital (Brockton, MA)
- … program that enhances the quality of patient care while optimizing resource utilization . Provides training to staff on case management methods and techniques. ... and develops reports that clearly monitor all areas of utilization /case management . Provides data, guidance and input...RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It… more
- Charter Care Health Partners (North Providence, RI)
- …of a specific patient population. Performs functions related to Patient Advocacy; Utilization Review; Resource Management ; Continuum of Care Management ... and Clinical Documentation Management . Collects data via utilization with Care Port to enhance the quality and...preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in… more
- Charter Care Health Partners (North Providence, RI)
- …of a specific patient population. Performs functions related to Patient Advocacy; Utilization Review; Resource Management ; Continuum of Care Management ... and Clinical Documentation Management . Collects data via utilization with Care Port to enhance the quality and...preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in… more
- Sharecare (Providence, RI)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Highmark Health (Providence, RI)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- Edwards Lifesciences (Providence, RI)
- …an impact:** + Working independently in the areas of valve crimping, case management , pre-case planning, post-case management , 3 Mensio management , Therapy ... implementing growth strategies within focused accounts in partnership with Sales Management . + Developing clinical champions among current and potential customers… more
- State of Massachusetts (Canton, MA)
- …and accreditation requirements. . Lead recruitment, training, supervision, and performance management of nursing and respiratory therapy staff to promote excellence, ... in hospital committees and leadership forums, contributing to policy development, utilization review, and organizational initiatives. . Represent nursing services in… more
- Brockton Hospital (Brockton, MA)
- …of five years clinical experience in an acute care facility required. Prior experience in case management , utilization review or discharge planning required. ... of our patients. Provides medical-surgical pediatric and obstetrical case management services to Brockton Hospital patients. Responsible for assuring continuity… more
- Oracle (Providence, RI)
- …alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal candidate ... sessions, and offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report progress to… more
- Edward M. Kennedy Community Health Center, Inc. (Milford, MA)
- …The Clinical Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to chronic disease patients, especially to those who are most at ... patients, ensuring optimal care including acute illness and chronic disease management , lifestyle and behavior education, and preventive care across multiple health… more