- Milford Regional Medical Center (Milford, MA)
- …with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization management at MRMC. The UR ... year Nurse Case Management experience Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual criteria more
- Beth Israel Lahey Health (Burlington, MA)
- …Medical Center is now offering up to a $3,500 in signing bonuses for our Utilization Review positions. Important Details: * Signing Bonuses are paid out in three ... Description:** **Job Description:** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate… more
- Beth Israel Lahey Health (Burlington, MA)
- …40 **Work Shift:** Day (United States of America) Joint role of Case Manager and Utilization Review Nurse Hospital at Home Full Time Days 8:00am-4:30pm ... and varying other shifts **Job Description:** The Inpatient Registered Nurse (RN) Case Manager for Hospital at Home Care...to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management … more
- Beth Israel Lahey Health (Boston, MA)
- …of America) Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... the level of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure… more
- Elevance Health (Woburn, MA)
- …as part of consideration for employment. **Medical Oncology Medical Director - Utilization Review ** + Job Family: MED > Licensed Physician/Doctor/Dentist + ... + New Jersey, Morristown **Description** **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits… more
- Humana (Boston, MA)
- …years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Experience compiling NCQA File Review Universes and timeliness reports ... Qualifications** + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health. + Detailed working knowledge… more
- Fallon Health (Worcester, MA)
- …a Registered Nurse in a clinical setting required. + 2 years' experience as a Utilization Management nurse in a managed care payer preferred. + One year ... fallonhealth.org or follow us on Facebook, Twitter and LinkedIn. The UM Nurse uses a multidisciplinary approach to organize, coordinate, monitor, evaluate and modify… more
- Beth Israel Lahey Health (Cambridge, MA)
- …America) Job Description Job Description Primary Responsibilities 1. The emergency nurse initiates accurate and ongoing assessment of physical, psychological and ... focused subjective and objective data through history taking, physical examination, review of records and communication with health care providers, significant… more
- Elevance Health (Woburn, MA)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... state(s) required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- State of Massachusetts (Boston, MA)
- … review of principles significant to performance improvement, risk management , environmental safety, infection control, emergency management , other important ... Public Health (DPH) is seeking an experienced individual to become our new Registered Nurse VI. The incumbent administers Nursing services in OR, ADS, PACU, GI and… more
- Baystate Health (Springfield, MA)
- …and provides support to the patient's primary care team regarding patients' utilization management needs. The Clinical Utilization Reviewer -LPN ... **Position** Licensed Practitioner Nurse **SCHEDULE:** + Full tim + Monday -...experience in home care and/or 2 years' experience in utilization management Certifications: + . Basic Life… more
- Beth Israel Lahey Health (Cambridge, MA)
- …Description:** **Primary Responsibilities** (including but not limited to): 1. Performs utilization review and discharge planning to inpatient admissions to ... Inpatient criteria approved by the MACIPA (risk) and MAH (non-risk) Utilization Management Committees to accurately determine appropriateness for inpatient… more
- Beth Israel Lahey Health (Needham, MA)
- …requirements are met and/or exceeded. Optimal patient care and cost effective management is maintained through utilization of data and information from ... is accountable for outcomes + Maintains competency commensurate of a nurse on the unit **Organizational** ** Management /Leadership/Communication** + Articulates… more
- Beth Israel Lahey Health (Burlington, MA)
- …parameters, physical assessments as related to drug monitoring and adverse effect management , review of medication profiles and the patient medical records ... **Work Shift:** Day (United States of America) **Job Description:** **Clinical Anticoagulation Nurse ** The registered nurse facilitates the coordination of care… more
- Beth Israel Lahey Health (Boston, MA)
- …nursing, and advocating for the health of patients, families, and communities. The Nurse Case Manager provides utilization management , care coordination and ... and competencies for this role are overseen by a Nurse Leader to the department. **Job Description:** Primary Responsibilities:...needed. (essential) 6. Refers cases as appropriate to the Utilization Review Physician for review … more
- Amergis (Burlington, MA)
- …and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making ... regarding accessibility of services + Follows State/County mandated guidelines for the nurse case management programs + Participates in outreach activities to… more
- Wellpath (Plymouth, MA)
- …care through adherence to policies and procedures for admission and transfer, utilization review , and referrals. + Assumes responsibility and accountability for ... substance use disorders. **How you make a difference** The Psychiatric Nurse Practitioner(Psych NP)follows established policies and procedures and state guidelines,… more
- Sedgwick (Boston, MA)
- …to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Medicare Compliance Nurse Team Lead **PRIMARY PURPOSE** **:** To supervise Medicare Compliance ... Nurses/Medicare Compliance Nurse Sr.; to ensure quality standards are achieved and...FUNCTIONS and RESPONSIBILITIES** + Provides insight and direction to management on report quality and compliance with all company… more
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …The Clinical Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to chronic disease patients, especially to those who are most at ... patients receive optimal care including acute illness and chronic disease management , education about lifestyle and behavior modification, and preventive care across… more
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …Clinical Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to Medical Assistant Treatment Program (MAT) patients. As an employer ... patients receive optimal care including acute illness and chronic disease management , education about lifestyle and behavior modification, and preventive care across… more