- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is ... and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets… more
- Beth Israel Lahey Health (Plymouth, MA)
- …years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the ... severity of an array illnesses, intensity of service, and care coordination needs + Ability to identify appropriateness of patients admission and level of care needs (inpatient & observation) utilizing Interqual criteria + Knowledge of Interqual required;… more
- CVS Health (Boston, MA)
- …opportunities to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal and external ... constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with productivity and… more
- Beth Israel Lahey Health (Plymouth, MA)
- …years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the ... severity of an array illnesses, intensity of service, and care coordination needs + Ability to identify appropriateness of patients admission and level of care needs (inpatient & observation) utilizing Interqual criteria + Knowledged of Interqual required;… more
- Commonwealth Care Alliance (Boston, MA)
- …is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA)...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- Children's Hospital Boston (Boston, MA)
- …Title:Per Diem RN Case Manager, Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard Hours per ... of payer denials. They identify and implement initiatives to manage utilization trends, collaborating with the hospital's discharge planning case managers,… more
- Fenway Health (Boston, MA)
- Registered Nurse , Per Diem Boston, MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing Job Type Part-time Description As a Registered ... Nurse (RN) at Fenway Health you will provide compassionate,...patient, and other care team members. + Influences appropriate utilization of healthcare resources by helping to coordinate patient… more
- Evolent (Boston, MA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We ... providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer, Nurse , you will routinely interact with leadership and management staff,… more
- CVS Health (Boston, MA)
- …AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support ... **Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year of experience in...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation… more
- CVS Health (Boston, MA)
- …AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support ... **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in...lower levels of care. + 1+ years' experience in Utilization Review. + CCM and/or other URAC recognized accreditation… more
- US Tech Solutions (Canton, MA)
- …required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that is expected to function independently in her / his ... of clinical decision making and support needed to perform utilization management, medical necessity determinations and benefit determinations using applicable… more
- Atrius Health (Braintree, MA)
- …value-based care system in the country. *_SUMMARY_*__ Physician Assistant/ Nurse Practitioner (MNA) position supporting our Orthopedics department. The Physician ... Assistant/ Nurse Practitioner will work collaboratively on a team to...care in Specialty. Demonstrated excellence in practice, documentation and utilization . Maintain high patient satisfaction. Ability to work effectively… more
- Atrius Health (Weymouth, MA)
- …the direction of the department chief, the incumbent is a certified Nurse Practitioner (NP) or Physician Assistant (PA) who possesses advanced training/skills in ... Serves as a patient educator in areas of specialization. *_EDUCATION/LICENSES/CERTIFICATIONS_* * Nurse Practitioner (NP) *- Must be nationally certified as an FNP… more
- Brockton Hospital (Brockton, MA)
- Registered Nurse (RN), Part-Time Flex Evenings, Emergency Signature Healthcare's Brockton Hospital is hiring for a Part-Time Flex Evenings Registered Nurse (RN) ... commitment to comprehensive patient care. Under the guidance of a Charge nurse , our team emphasizes efficient throughput, flexibility, and autonomy in initiating… more
- Brockton Hospital (Brockton, MA)
- Periop-101/Transition to Practice OR Nurse Signature Healthcare's Brockton Hospital is hiring Full time Registered Nurse (RN)'s for a Periop-101/Transition to ... will be required to fulfill call requirements with a 30-minute response time. Registered Nurse (RN) Roles and Responsibilities: Specific Duties: + The Nurse will… more
- Baylor Scott & White Health (Boston, MA)
- **LOCATION:** Remote **SPECIALTY/DEPARTMENT:** Care Management: Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** Full-time days, ... vary based on position type and/or level **Job Summary** A Registered Nurse in Nursing Professional Development Generalist role uses expertise to enhance healthcare… more
- Atrius Health (Weymouth, MA)
- …the country. *SUMMARY* Under the direction and supervision of a Department Chief, Nurse Leader or designee, this licensed practical nurse provides direct patient ... practical nursing. Possess a current license to practice as a practical nurse in the Commonwealth of Massachusetts.American Heart Association Basic Life Support… more
- Sharecare (Boston, MA)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is ... To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and objectives of the… more
- Brockton Hospital (Brockton, MA)
- Registered Nurse (RN), J ob, (Very Specific Shift-Type) , (Department/Unit) Signature Healthcare's Brockton Hospital is hiring for a (shift type) Registered Nurse ... stronger than ever. Insert Department/Unit Insert Department/Unit Description Registered Nurse (RN) Roles and Responsibilities: + Assessment: collects relevant… more
- Brockton Hospital (Brockton, MA)
- …and health of our patients. Position Summary: Purpose of Position: The Registered Nurse provides nursing care to assigned patients newborn to geriatric according to ... of the Department of Nursing and in compliance with Massachusetts Nurse Practice Act. Independent Action: Functions independently within established department… more