- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… 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 ... reports to the Director of Utilization Management * Oversees clinical decision review for...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- US Tech Solutions (Canton, MA)
- …all aspects of clinical decision making and support needed to perform utilization management , medical necessity determinations and benefit determinations using ... criteria through participation in the IMPAC. + Proactively identifies trends in Utilization Management applicable to the precertification and outpatient UM… more
- Lincoln Financial (Boston, MA)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Beth Israel Lahey Health (Burlington, MA)
- …you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered ... the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg… more
- Zurich NA (Boston, MA)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review , catastrophic or disability experience + 5 ... AVP, Utilization Review & Pharmacy 123092 Zurich...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities… more
- Evolent (Boston, MA)
- …appeals. **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review as an LPN or LVN is required. + Must ... team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and… more
- State of Massachusetts (Boston, MA)
- …social workers, physicians, and professional staff, while also participating in Census and Utilization Review Committees under the guidance of the Director of ... for complex admissions, ensuring access for special populations./ * /Prepare reports for utilization review and census meetings./ * /Assist the CEO with public… more
- Beth Israel Lahey Health (Cambridge, MA)
- …difference in people's lives.** Join our team as a key Emergency Department nurse in our renovated and expanded department, caring for approximately 34,000 patients ... to older adults. **Job Description:** **Primary Responsibilities** 1. The emergency nurse initiates accurate and ongoing assessment of physical, psychological and… more
- HCA Healthcare (Derry, NH)
- …**Job Summary and Qualifications** The Case Manager's primary duties are to provide Utilization Review and Case Management functions for the ... encourage you to apply for our RN Case Manager Registered Nurse PRN opening. We review all applications. Qualified candidates will be contacted for interviews.… more
- Sharecare (Boston, MA)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- HCA Healthcare (Derry, NH)
- …preferred. + Minimum two years of experience in Case Management and/or Utilization Management Review , or relevant professional experience. + Three years ... care?** Submit your application for RN Case Manager Registered Nurse CM position and spend more time at the...clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Parkland… more
- Evolent (Boston, MA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management … more
- Highmark Health (Boston, MA)
- …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or… more
- Cambridge Health Alliance (Cambridge, MA)
- …team leader in multi-disciplinary team discussion regarding treatment planning, treatment review , quality assurance and utilization review ... Nurse Practitioner - Clinical Specialist II (APRN), Psychiatry...to nursing policy and procedure. + Communicate effectively with management , peers, and health team members. + Interact effectively… more
- Tufts Medicine (Burlington, MA)
- …The position provides day to day support and oversight to Utilization Review departments and UM vendor management . The UM Operations Manager is responsible ... Utilization Review and Discharge Planning including implementation and annual review of the Utilization Management Plan and assisting with the… more
- Evolent (Boston, MA)
- …years of direct clinical patient care + **Minimum one year of experience with Utilization Review (UM) in a managed care environment** + **Cardiology and Oncology ... better health outcomes. **Collaboration Opportunities:** + Works with the physician reviewer to monitor the adverse determination process and ensure notification… more
- Beth Israel Lahey Health (Boston, MA)
- …patient delivery systems. Collects quality and variance data as well as utilization management . Utilizes clinical experiences and expertise in conjunction with ... care, dietetic, Elder Care and other clinical services. 4. Utilization Management /Managed Care: * Coordinates and organizes...trends and analyze reports. * Provides data for the Utilization Review Committee. 7. Fiscal: Under the… more
- WTW (Boston, MA)
- …reviewed including master templates and client specific responses + Collaborate with health management senior reviewer and Project Manager to conduct follow up ... + Health analytics experience preferred + Understanding of health plan utilization /case management processes, network management , credentialing, quality… more