- 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
- 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
- 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
- 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
- Brockton Hospital (Brockton, MA)
- …readmissions, improve HCAHPS, drive positive discharge outcomes and reduce LOS, and review ER utilization using proactive approaches to any barriers. The ... total medical expense of high risk/high cost patients * Providing Transitional Care Management (TCM) services for eligible patients as they transition back to the… more
- Beth Israel Lahey Health (Burlington, MA)
- …System Coordinators in par level establishment and maintenance, refill process, utilization analysis and product management . Collaborates with Purchasing Agent ... Manager, and in conjunction with the appropriate clinical personnel, (ie department nurse manager or clinical manager), coordinates and manages the procurement of… more
- Erickson Living (Peabody, MA)
- …clinical leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management /Safety ... opportunity to mentor staff and support their professional growth. If you're a nurse looking for a fulfilling career with opportunities for growth and development,… more
- Amergis (South Weymouth, 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
- Tufts Medicine (Burlington, MA)
- …hospital setting (ICU, ED, Critical Care, strong Med/Surg Specialty) or equivalent case management , utilization review , denials management , or ... Qualifications:** 1. Bachelor's Degree in Nursing 2. Active Registered Nurse (RN) license in Massachusetts or compact state 3....other Quality indicators where indicated. 10. Collaborates with case management and utilization review team… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …strategies. Your Day to Day: + With minimal oversight, leads CMS utilization management related compliance activities including: + Identify and implement ... interpret/ draw conclusions, identify gaps/ issues & analyze information from the utilization management medical management system: Care Prominence (ie… more
- Highmark Health (Boston, MA)
- …member is responsible for building relationships, engaging clinicians, educating on Utilization Management policies and processes, developing workflows and ... or healthcare consulting in provider setting. + 3 years of experience in utilization management /care management /QA/managed care **Preferred** + 3 years… more
- Commonwealth Care Alliance (Boston, MA)
- …improving member experience through care transitions, promoting the appropriate utilization of clincial services, and reducing unnecessary hospital admissions and ... in orienting and training new employees + Participate in case review and quality improvement projects + Maintain professional licensing, credentialing, and… more