- Molina Healthcare (Boston, MA)
- …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...with a MA RN licensure. Candidates with UM Medical Review background and experience using… more
- Commonwealth Care Alliance (Boston, MA)
- …Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management ( UM ) Reviewer is responsible for day-to-day ... timely clinical and service authorization review for medical necessity and decision-making. The ...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance… more
- Tufts Medicine (Burlington, MA)
- …due to medically neuticessary care and/or if there is disagreement between UM RN and attending Physician in determining appropriate patient status. 13. ... issues related to the utilization of resources, coordination of care across the continuum and utilization review ...management (ACM, CCM, CMAC) 4. Seven (7) years of UM /Case Management experience in an acute- care hospital… more
- Commonwealth Care Alliance (Boston, MA)
- …for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting centralized clinical ... Audits, or EQRO reviews). * Hire, train and mentor UM staff, including nurse reviewers and support...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance… more
- Commonwealth Care Alliance (Boston, MA)
- …and driving record, (if applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an equal opportunity ... Translate regulatory updates into operational actions, collaborating with Claims, Appeals, UM , and Provider Services. * Conduct internal audits and retrospective… more