- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in… more
- Cognizant (Boston, MA)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals… more
- Beth Israel Lahey Health (Cambridge, MA)
- …completed). **KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED** 1. RN with experience in risk management , quality assessment, or utilization management . 2. Strong ... to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by leading the… more
- Commonwealth Care Alliance (Boston, MA)
- …influence the clinical outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment for chronic disease management , and closing ... in primary care or care management , including: + 5+ years' experience as Registered Nurse in a high touch clinical environment or home care + AND + 2+ years… more
- Brockton Hospital (Brockton, MA)
- … program that enhances the quality of patient care while optimizing resource utilization . Provides training to staff on case management methods and techniques. ... systems, plans and develops reports that clearly monitor all areas of utilization /case management . Provides data, guidance and input on the development… more