- Beth Israel Lahey Health (Plymouth, MA)
- …using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- Beth Israel Lahey Health (Burlington, MA)
- …people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse (RN) Case Manager for ... Clinic inpatient admissions. Leads the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case… more
- Zurich NA (Boston, MA)
- AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is seeking an AVP, Utilization Review & Pharmacy. This is a fully remote position, offering ... flexibility of a home-based office. As the AVP of Utilization Review & Pharmacy, you will lead...more years of experience in the Nursing areaAND + Registered Professional Nurse license in residential area… more
- Beth Israel Lahey Health (Burlington, MA)
- …collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities ... Duties & Responsibilities** _including but not limited to:_ + Ensures that Utilization Review nurses are consistently recommending the appropriate admission… more
- Sharecare (Boston, MA)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and… more
- Fresenius Medical Center (Springfield, MA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- State of Massachusetts (Boston, MA)
- …social workers, physicians, and professional staff, while also participating in Census and Utilization Review Committees under the guidance of the Director of ... ensuring access for special populations./ * /Prepare reports for utilization review and census meetings./ * /Assist...years of full-time, or equivalent part-time, experience as a registered nurse in a recognized hospital, clinic… more
- Baystate Health (Springfield, MA)
- …- American Heart AssociationAmerican Heart Association, Driver License - OtherOther, Registered Nurse - State of MassachusettsState of Massachusetts **Equal ... **RN, ACO Nurse Care Manager, Community Health Center** The **ACO...room, or from a skilled nursing facility. Responsible to review the discharge summaries, follow up on testing that… more
- Lincoln Financial (Boston, MA)
- …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like… more
- Tufts Medicine (Burlington, MA)
- …**Job Overview** The position provides day to day support and oversight to Utilization Review departments and UM vendor management. The UM Operations Manager ... is responsible for compliance with CMS Conditions of Participation regarding Utilization Review and Discharge Planning including implementation and annual … more
- Brockton Hospital (Brockton, MA)
- …delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare ... primary responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It… more
- Beth Israel Lahey Health (Boston, MA)
- …or lack thereof, current trends and analyze reports. * Provides data for the Utilization Review Committee. 7. Fiscal: Under the direction of the Service Line ... **EDUCATION** **Required:** Bachelor's of Science in Nursing **LICENSURE/CERTIFICATION/REGISTRATION** Required: Registered Nurse , State MA Graduate of an… more
- Beth Israel Lahey Health (Plymouth, MA)
- …job that may reasonably be required._ **Education/Experience Required:** _Required_ + State of MA Registered Nurse (RN) + 3-5 years acute care nursing + Two ... 3) Decreasing unit cost, 4) reducing readmissions. **Duties/Responsibilities:** **A. Utilization Management** Performs review of anticipated admissions utilizing… more
- Baystate Health (Springfield, MA)
- …DIVERSE LOCATIONS. **Education:** Bachelors Degree in Nursing (Required) **Certifications:** Certified Registered Nurse - OtherOther, Registered Nurse ... strongly preferred + Requires a working knowledge of community resources and Utilization /Quality Review standards. + Understanding of the hospitals patient… 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 ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Veterans Affairs, Veterans Health Administration (Boston, MA)
- …per week. Responsibilities Duties include, but are not limited to: Case Management Utilization Review Clinical Expertise on Office of Community Care Process and ... to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge… more
- Erickson Living (Peabody, MA)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... (skilled nursing, long term care, assisted living or hospital) is required. + Current Registered Nurse license for the state in which they operate. + Current… more
- State of Massachusetts (Wrentham, MA)
- …have at least (A) four years of full-time or equivalent part-time experience as a registered nurse in a recognized hospital, clinic, or medical facility and (B) ... from an approved school of nursing must have applied for the first available registered nurse examination. Based on assignment, possession of a current and valid… more
- Baystate Health (Springfield, MA)
- The **RN Hospital Case Manager** is a registered nurse responsible for the coordination of clinical care, quality, and financial outcomes of a designated ... and Competencies:** + Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by third party payers… more
- Tufts Medicine (Burlington, MA)
- …technology. **Job Description** **Minimum Qualifications:** 1. BSN degree 2. Licensed as a Registered Nurse 3. Five (5) years relevant experience in the ... with multiple revenue cycle and hospital departments, such as Coding, Utilization Management (UM), Case Management, Quality and Physician advisors and leaders.… more