- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring… more
- Commonwealth Care Alliance (Boston, MA)
- …Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... Management reports to the Director of Utilization Management - Oversees clinical ...reviews). - Hire, train and mentor UM staff, including nurse reviewers and support personnel. - Act as liaison… more
- Commonwealth Care Alliance (Boston, MA)
- …- Recommend resource allocation to meet patient and clinic needs - Oversee clinical supply management inventory and control costs without compromising quality of ... experience including: - 3+ years' experience as a Registered Nurse in a high-touch clinical environment or...(video, chat, etc.), when appropriate, for a variety of clinical care and care management services. Required… more
- Commonwealth Care Alliance (Boston, MA)
- …Access Operations and in direct partnership with Care Delivery Business Ops and Clinical Management teams, the Supervisor partners in ensuring the delivery of ... collaborating with the Interdisciplinary Care Team members and/or other Clinical staff and management . In addition, the...(nice to have): - Medical Assistant or Licensed Practical Nurse - Coding Certification Required Experience (must have): -… more
- CVS Health (Boston, MA)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- Cognizant (Boston, MA)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- Humana (Providence, RI)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Boston, MA)
- … (UM) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all ... and state regulated turn-around times. This includes reviewing written clinical records. **Key Responsibilities of the UM Nurse...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… more
- CVS Health (Boston, MA)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Beth Israel Lahey Health (Plymouth, MA)
- …recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of ... establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical… more
- Beth Israel Lahey Health (Plymouth, MA)
- …recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of ... establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical… more
- Commonwealth Care Alliance (Boston, MA)
- …Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... Management reports to the Director of Utilization Management * Oversees clinical ...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- CVS Health (Boston, MA)
- … skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Veterans Affairs, Veterans Health Administration (Brockton, MA)
- Summary This Registered Nurse (RN) position as a Clinical Analyst is in the Quality and Patient Safety service of the Boston VA Healthcare System and is located ... permanent and full-time at 40 hours per week. Responsibilities The Clinical Analyst will demonstrate professionalism by building, supporting, and creating alignments… more
- Evolent (Boston, MA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Sharecare (Boston, MA)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Commonwealth Care Alliance (Boston, MA)
- …in primary care or care management , including: + 5+ years' experience as Registered Nurse in a high touch clinical environment or home care + AND + 2+ ... the clinical outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment for chronic disease management , and closing… more
- University Medicine (Providence, RI)
- SUMMARY: Reporting to the Manager of Case Management , the nurse case manager is responsible for providing comprehensive screenings, assessment, care coordination ... services, disease education with the intent of encouraging self- management for patients with chronic conditions. The Nurse...to the right level of care and decrease unnecessary utilization . The nurse case manager is an… more
- Fenway Health (Boston, MA)
- …patient-centeredness, non-judgmental, harm reduction, behavioral health integration, and team-based care. The nurse serves in a clinical leadership role to the ... Registered Nurse Boston, MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing Job Type...care team with primary responsibilities for disease management , care coordination, and advice/triage needs for the care… more
