- Cognizant (Providence, RI)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Humana (Providence, RI)
- …a part of our caring community and help us put health first** The Weekend Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... Communities is good for the Soul. Join Us!** The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the (appropriate state)… more
- CVS Health (Woonsocket, RI)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… 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 ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- Atrius Health (Easton, MA)
- …Department Chief, Nurse Leader or designee, this registered professional nurse provides practice support to a clinical team, recognizing the patient as ... health and welfare benefit package. **Job:** **Nursing* **Organization:** **Family Practice* **Title:** * Registered Nurse (MNA) Family Medicine - Easton - Full… more
- Fallon Health (Worcester, MA)
- …Degree in nursing, or equivalent. **License:** Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience:** Three to five years of ... of clinical criteria and medical necessity determinations. The Appeal Nurse is responsible for ensuring compliance with all applicable state and federal… more
- State of Massachusetts (Westborough, MA)
- …suite (Excel, Access, Word, and Microsoft project). *_Special Requirements:_* Licensed Registered Nurse /*_TO APPLY:_*/ /*__*/ Please upload both Resume ... the ability to quickly learn their needs Experience conducting clinical assessments and utilization review Ability to...year of full-time or equivalent part-time, experience as a registered nurse in a recognized hospital, clinic… more
- Lincoln Financial (Providence, RI)
- …**What we're looking for** Education * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where ... 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… more
- Edward M. Kennedy Community Health Center, Inc. (Milford, MA)
- …may require evening, weekend and/or holiday shifts on a rotating basis. Job Requirements: + Registered Nurse License in MA + 1-2 years of clinical experience ... to support this growth. We are currently hiring a Clinical Care Manager based in Milford, MA. The ...patient engagement, reduce risk, and minimize hospital and ER utilization . + Identifies, manages, and coordinates patient care, providing… more
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …require evening, weekend and/or holiday shifts on a rotating basis. Required Qualifications: + Registered Nurse License in MA + Bachelor's degree in Nursing from ... to support this growth. We are currently hiring a Clinical Care Manager - OBAT RN based in Framingham....self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and… more
- Fallon Health (Worcester, MA)
- … Nurse in Massachusetts. **Experience** + A minimum of three to five years clinical experience as a Registered Nurse in a clinical setting ... nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences,...required. + 2 years' experience as a Utilization Management/Prior Authorization nurse in a managed… more
- Charter Care Health Partners (North Providence, RI)
- …Graduate of a School of Nursing (BSN preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in the nurse 's ... Resource Management; Continuum of Care Management (Discharge planning) and Clinical Documentation Management. Collects data via utilization ...residency if that state is a member of the Nurse Licensure Compact. Five (5) years of clinical… more
- Charter Care Health Partners (North Providence, RI)
- …Graduate of a School of Nursing (BSN preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in the nurse 's ... Resource Management; Continuum of Care Management (Discharge planning) and Clinical Documentation Management. Collects data via utilization ...residency if that state is a member of the Nurse Licensure Compact. Five (5) years of clinical… more
- Fallon Health (Worcester, MA)
- …minimum of two years' clinical experience as a licensed Registered Nurse managing/coordinating/facilitating/providing care for member populations required * ... related field preferred **License** : Active, unrestricted license as a Registered Nurse in Massachusetts **Certification:** Certification in Case Management… more
- Molina Healthcare (Norfolk, MA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... Job Summary The Care Review Clinician, IP Provides support for clinical member services review assessment processes. Responsible for verifying that services… more
- Tufts Medicine (Framingham, MA)
- …direction of physicians, mid-level practitioners, and may work under the direction of registered nurses depending on their unit. A clinical technologist role ... outpatient/ambulatory setting. The position is a patient liaison through both clinical and administrative responsibilities. This position plays an important role in… more
- University Medicine (East Providence, RI)
- …endoscopy population of Brown Medicine under the direct supervision of a registered nurse (RN). PRINCIPAL DUTIES AND RESPONSIBILITIES: Consistently applies the ... cleaning and disinfection of equipment. + Demonstrates strong understanding and utilization of infection prevention practices. + Maintains appropriate levels of… more