- Humana (Boston, MA)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... receives guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA… more
- CVS Health (Boston, MA)
- …Must be willing and able to work Monday through Friday, 8:00am to 5:00pm. Utilization management is a 24/7 operation. Work schedules will include weekend/holiday ... zone + 3+ years of experience as a Registered Nurse + 3+ years of clinical experience required +...+ Managed Care experience + Discharge planning experience + Utilization Management experience **Education** Associates Degree or… more
- CVS Health (Boston, MA)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST and CST zones.… 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 for ... & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the… more
- 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 ... compliance reviews as needed. + Continuously monitors regulatory requirements for Utilization Management . + Attends Mandatory Education programs required by… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- Beth Israel Lahey Health (Burlington, MA)
- …of three years of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated ... in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient...to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and… more
- Zurich NA (Boston, MA)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- Atrius Health (Watertown, MA)
- …package. **Job:** **Nursing* **Organization:** **Clinical Programs* **Title:** *Licensed Practical Nurse (LPN) Anticoagulation Management Service - Remote* ... care system in the country. *SUMMARY* Under the direction and supervision of a Nurse Leader or designee, this licensed practical nurse provides direct patient… more
- State of Massachusetts (Boston, MA)
- …and admission data interpretation./ * /Provide backup support as Case Management Nurse when needed./ /*_Required Qualifications:_*//*__*/ * Strong ... Massachusetts Department of Public Health (DPH), is seeking a skilled Screening Nurse Liaison to oversee patient admissions. This role involves assessing prospective… more
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- Summary Registered Nurse -Inpatient CLC positions at the Bedford Healthcare System. This position is full-time 40 hours per week. This is an open continuous ... as vacancies become available. This OCA may be used to fill a Registered Nurse (RN) position that is located in the one of following services and specialties:… more
- Fenway Health (Boston, MA)
- Registered Nurse , Part-Time Boston, MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing Job Type Part-time Description As a Registered ... Nurse (RN) at Fenway Health you will provide compassionate,...to the care team with primary responsibilities for disease management , care coordination, and advice/triage needs for the care… more
- Evolent (Boston, MA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Sharecare (Boston, MA)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… 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 ... making a difference in people's lives.** The Care Manager, RN provides care management services to the BILHPN primary care physicians focusing on at risk, high… 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
- Atrius Health (Burlington, MA)
- …in the country. *SUMMARY * Under the direction of the Department Chief, Nurse Leader or designee, this registered professional nurse provides practice support ... across the lifespan. This position is responsible for effective care delivery and management of patient care within a specialty, utilizing the nursing process and… more
- Atrius Health (Boston, MA)
- …system in the country. *SUMMARY* Under the direction of the Department Chief, Nurse Leader or designee, this registered professional nurse provides practice ... patients *age 18*. This position is responsible for effective care delivery and management of patient care within a specialty, utilizing the nursing process and… more
- Highmark Health (Boston, MA)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more