- 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 ... Role is Important to Us:** The Nurse Utilization Management (UM) Reviewer is... review for medical necessity and decision-making. The Utilization Management Reviewer has a… more
- 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 holiday rotations required **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
- Elevance Health (Woburn, MA)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Baystate Health (Springfield, MA)
- …support to the patient's primary care team regarding patients' utilization management needs. The Clinical Utilization Reviewer -LPN is responsible ... **Position** Licensed Practical 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 (Cambridge, MA)
- …lives.** 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
- 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 and… more
- Beth Israel Lahey Health (Wakefield, MA)
- …system considered in lieu of degree + Active, unrestricted Massachusetts Registered Nurse License required. Certification in Case Management (CCM) preferred. NH ... of population health and is responsible to ensure that quality, efficient care management services are provided to the BILHPN provider's risk populations. The Care… more
- Baystate Health (Springfield, MA)
- …and Competencies:** + Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by third party payers ... Time, RN Case Manager** to join their **Inpatient Case Management Team.** The Hospital Case Manager is a registered... Team.** The Hospital Case Manager is a registered nurse responsible for the coordination of clinical care, quality,… more
- Fallon Health (Springfield, MA)
- …oriented, person-centered care, disease progression, disease prevention, wellness and management of chronic and episodic illness consistent with the participant's ... to Summit ElderCare program participants focusing on disease prevention, wellness and management of chronic and episodic illness. Addresses advance directives in a… more
- Edward M. Kennedy Community Health Center, Inc. (Milford, 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
- Trinity Health (Springfield, MA)
- …ACM Certification preferred. **Preferred Skills:** + **Experience:** 3-5 years in Case Management , Utilization review , or similar experience preferred. ... to ensure seamless communication and coordination of care. + **Resource Management ** : Optimizing the use of resources, including medical equipment, personnel,… more
- Baystate Health (Springfield, MA)
- …clinical and non-clinical patient flow and throughput, utilizing leadership, project management , data analysis, and process improvement skills. The Patient Flow ... Patient Flow while engaging ancillary departments as necessary 5) Ensures optimal utilization of resources (including but not limited to staff, equipment, and… more
- Trinity Health (Springfield, MA)
- …of Science in Nursing BSN degree preferred. + **Experience:** 3-5 years in Case Management , Utilization review , or similar experience preferred. Hospital or ... program. BSN graduate preferred. + **Licensure** : Current Licensure as a Registered Nurse RN in Massachusetts. + **Certification** : BLS (AHA/ARC). CCM or ACM… more
- Fresenius Medical Center (West Springfield, MA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Marriott (Boston, MA)
- …with Claims department regarding case management . + Collaborate with UNM on utilization review issues. + Refer catastrophic cases in coordination with claims ... **Schedule** Full-Time **Located Remotely?** Y **Relocation?** N **Position Type** Management **JOB SUMMARY** The Nurse CARE Manager...from case management to meet jurisdictional needs. Utilization Review + Provide initial clinical … more
- Baystate Health (Springfield, MA)
- … management as outlined in the evidence based practice guidelines Uses Utilization Analysis / Management principles, insures that patient's site of care ... strongly preferred + Requires a working knowledge of community resources and Utilization /Quality Review standards. + Understanding of the hospitals patient… more