- Milford Regional Medical Center (Milford, MA)
- …services to our community with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization ... 1 year Nurse Case Management experience Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual criteria more
- University Medicine (East Providence, RI)
- …to assist the patient to the right level of care and decrease unnecessary utilization . The nurse case manager is an active participant in the coordination ... SUMMARY: Reporting to the Manager of Case Management, the nurse case manager is responsible for providing comprehensive screenings, assessment, care coordination… more
- Universal Health Services (South Attleboro, MA)
- …team and identifying patient treatment needs, medication assessments and adjustments, and utilization review support as needed. Fuller Hospital is a 109-bed ... Responsibilities Psychiatric Nurse Practitioner Opportunity Fuller Hospital is seeking a...leaders that educate the field, routinely exchange ideas, and review current topics within the industry. Having the opportunity… more
- Humana (Providence, RI)
- …to improve the lives of others. **Essential Duties and Responsibilities:** + Review PA requests for home health services, durable medical equipment, outpatient ... Medicaid criteria, iCare guidelines, and PA Department policies and procedures. + Review PA requests for inpatient medical stays, skilled nursing facility stays,… more
- Edward M. Kennedy Community Health Center, Inc. (Milford, MA)
- …engagement in self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and provides ongoing ... point-of-care testing, treatments, and lab and diagnostic test result review + Documents patient care, ongoing evaluation, patient progress/risk status,… more
- Marriott (Providence, RI)
- …workers' compensation losses. The NCM is responsible for conducting first level Utilization Review and coordinates subsequent levels if necessary, as required ... **Additional Information** Nurse CARE Manager (CARE - Coordinated Action and...that may include multiple states. + Conducts first level utilization review per jurisdictional requirements. + Coordinates… more
- Charter Care Health Partners (North Providence, RI)
- …a specific patient population. Performs functions related to Patient Advocacy; Utilization Review ; Resource Management; Continuum of Care Management (Discharge ... preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in...recent experience with case management, patient navigation, case management, utilization review or discharge planning is strongly… more
- Evolent Health (Providence, RI)
- …with call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. + ... Reviewer, you will be a key member of the utilization management team. We can offer you a meaningful...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… 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 ... the patient's primary care team which includes the MD/NP, social worker, nurse , secretary, medical assistant, and other key stakeholders/staff as needed. The… more
- Highmark Health (Providence, RI)
- …network providers to support key clinical transformation programs with a focus on utilization of appropriate care. The team member works with internal and external ... is responsible for building relationships, engaging clinicians, educating on Utilization Management policies and processes, developing workflows and resources, and… more
- Brockton Hospital (Brockton, MA)
- …of five years clinical experience in an acute care facility required. Prior experience in case management, utilization review or discharge planning required. ... the delivery of services. Uses accepted criteria and guidelines to conduct review of inpatient admissions. The Case Manager at Brockton Hospital serves as… more