- 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
- Humana (Providence, RI)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… 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
- Beth Israel Lahey Health (Needham, MA)
- …clinical leader to bring best clinical practice to the bedside. The nurse manager provides 24-hour operational accountability for their unit(s). Collaborates with ... improvement activities to enhance patient care and improve service. Additionally, the Nurse Manager participates in the development of and implementation of care and… more
- State of Massachusetts (Marlborough, MA)
- …within Massachusetts nursing homes, hospitals and other health care facilities, and review inspection findings. The Health Care Facility Surveyor will play a vital ... in order to determine the degree of acceptance and utilization of health care, type and breadth of service,...3-5 years of professional work experience as a Registered Nurse working in a health care facility, preferably nursing… 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
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …engagement in self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and provides ongoing ... medication reconciliation, point-of-care testing, treatments, and lab and diagnostic test result review + Provides timely and informed patient triage + Involves the… 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
- CenterWell (Marlborough, MA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … 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
- Edward M. Kennedy Community Health Center, Inc. (Worcester, MA)
- …responsibility is to provide clinical and administrative support to the Home Health Utilization Nurse and the agencies Kennedy Community Health partners with. ... to track patients and their services. + Escalate concerns to Home Health Utilization Nurse appropriately. + Performs general clerical duties, including document… 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
- Tufts Medicine (Framingham, MA)
- …providers who are absent, etc.) by making continual adjustments in room utilization and assignment. 2. Prepares medical record for patient visit, confirming accuracy ... arranging for diagnostic testing, surgery and in-patient admissions under direction of the nurse or physician. 14. Assists with patient billing by ensuring CPT code,… more
- Edward M. Kennedy Community Health Center, Inc. (Worcester, 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 + Provides timely and informed patient triage +...center and nursing standards Education and Experience + Registered Nurse License in MA + Bachelor's degree in Nursing… more