- CenterWell (Boston, MA)
- …part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- Commonwealth Care Alliance (Boston, MA)
- …Reporting to the Manager Utilization Management, the Nurse Utilization Management ( UM ) Reviewer is responsible for day-to-day timely clinical and service ... with Standard Operating Procedures + Ensures accurate documentation of clinical decisions and works with UM Manager...Utilization Management experience in a managed care setting + 2 or more years working in a clinical… more
- Tufts Medicine (Burlington, MA)
- …standardized queries, and technology. **Job Description** **Minimum Qualifications:** 1. BSN degree 2 . Licensed as a Registered Nurse 3. Five (5) years ... strategy and oversight. The Director will partner with the Senior Director, Clinical Revenue Cycle to strategically plan, organize, implement, and evaluate the CDI… more
- Humana (Boston, MA)
- …QUALIFICATIONS:** + Bachelor's degree or equivalent experience + 5+ years of previous clinical experience in utilization management + 2 + years of indirect or ... + Registered nurse (RN) with unrestricted licensed **OR** independent licensed clinical social worker (LCSW) + Master's degree + Knowledge of Medicaid regulatory… more
- Humana (Boston, MA)
- …+ Registered nurse (RN) with unrestricted licensed **OR** independent licensed clinical social worker + 5+ years of previous clinical experience in ... Establish standardized protocols and workflows across the enterprise. + Lead activities regarding UM annual evaluation + Lead activities related to UM Program… more