- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities… more
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible ... reports to the Director of Utilization Management * Oversees clinical decision review for...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- 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 ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The Role The RN Utilization Management Reviewer is responsible for facilitating care ... to provide the best quality care. The Team The RN Utilization Management Reviewer...against a license must be disclosed and reviewed + Registered nurses only, bachelor's degree in nursing (BSN) preferred… more
- US Tech Solutions (Canton, MA)
- …required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that is expected to function independently in her / ... of clinical decision making and support needed to perform utilization management , medical necessity determinations and benefit...the job** + Bachelor's degree in Nursing, preferred + Registered Nurse with current a and unrestricted… more
- Children's Hospital Boston (Boston, MA)
- 80451BRJob Posting Title:Per Diem RN Case Manager, Utilization Management /ReviewDepartment:Patient Services-Patient Care ... Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current...preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse ( RN ) + A… more
- Commonwealth Care Alliance (Boston, MA)
- …local regulatory guidelines. + Serve as the lead for CCA's Utilization Review functions working closely with other medical management team members. + Support ... case review findings, actions, and outcomes in accordance with Utilization + Management policies; meets health plan inter-rater reliability guidelines… more
- Beth Israel Lahey Health (Burlington, MA)
- …in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse ( RN ) Case ... a timely process. Registered Nurses (RNs) with utilization review experience, case management ...the needs of the department. **Minimum Qualifications:** Education: * Registered Nurse , Bachelors Degree or commensurate experience… more
- Amergis (Canton, MA)
- …to facility wide personnel. + Demonstrated understanding of external agency interface with Utilization Review , Case Management , Patient Safety and Quality ... $3595 / Week Amergis Healthcare is seeking an experienced Registered Nurse and self-motivated individual to provide...collection and related activities for Quality Improvement (QI) and Utilization Review as well as completion of… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …TeamAs an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a liaison and business expert for member and ... your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound...provider submitted appeals. Working collaboratively with Physician review unit, Utilization Management ,… more
- Beth Israel Lahey Health (Wakefield, MA)
- …considered in lieu of degree + Active, unrestricted Massachusetts Registered Nurse License required. Certification in Case Management (CCM) preferred. NH ... to the BILHPN provider's risk populations. The Care Manager, RN provides care management services to the...behavior. Working with the healthcare team, the Care Manager, RN monitors appropriate utilization of healthcare resources,… more
- Children's Hospital Boston (Boston, MA)
- …concurrent review process for acute psychiatric care + Possessing experience in Utilization Management / Utilization Review + Demonstrating the ability ... Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current...preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse ( RN ) + A… more
- Tufts Medicine (Lowell, MA)
- …needs in a timely manner + Assist with management of unit schedule + The resource RN will act as the charge nurse when assigned on the unit + Round on ... Clinical Resource Nurse .** The ED Clinical Resource Nurse is a Registered Nurse ...utilization of all resources. The ED Clinical Resource Nurse utilizes the nursing process, leadership skills and current… more
- Highmark Health (Boston, MA)
- …Highmark Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... + Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN … more
- CVS Health (Boston, MA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Molina Healthcare (Cambridge, MA)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... identifying opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational… more
- Actalent (Boston, MA)
- …policies and standards. Essential Skills + Proficiency in clinical review , case management , utilization review , and utilization management . ... Clinical Review Clinician Job Description As a Clinical ...Medicare, and Medicaid regulations is preferred. + Familiarity with utilization management processes is preferred. + State… more
- Tufts Medicine (Burlington, MA)
- …in cooperation with multiple revenue cycle and hospital departments, such as Coding, Utilization Management (UM), Case Management , Quality and Physician ... organize, implement, and evaluate the CDI program. This includes management of case mix index (CMI), length of stay...**Minimum Qualifications:** 1. BSN degree 2. Licensed as a Registered Nurse 3. Five (5) years relevant… more
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …require evening, weekend and/or holiday shifts on a rotating basis. Required Qualifications: + Registered Nurse License in MA + Bachelor's degree in Nursing from ... are currently hiring a Clinical Care Manager - OBAT RN based in Framingham. As part of a team-based...Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to Medical Assistant Treatment Program (MAT) patients. As… more