- Milford Regional Medical Center (Milford, MA)
- …services to our community with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization ... 1 year Nurse Case Management experience Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual criteria more
- Lincoln Financial Group (Boston, MA)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... procedures, and facilities under the provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely… more
- Sedgwick (Boston, MA)
- …and consult review ; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review . **Skills & ... Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital...RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical bills from providers including… more
- Point32Health (Canton, MA)
- …competence in directing operational compliance with CMS regulatory and NCQA, URAC ( Utilization Review Accreditation Commission) or DOI (Division of Insurance) ... and modifying the business processes and operations for all levels of utilization management review (ie, Precertification and Intake Services, Inpatient &… more
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- …by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities VA offers a comprehensive total rewards ... package: VA Nurse Total Rewards This is an open continuous announcement...education, orientation, competencies and providing quality improvement and outcomes utilization consultation. Demonstrates leadership in delivering and improving holistic… more
- Baystate Health (Springfield, MA)
- **Position** Licensed Practical Nurse **SCHEDULE:** + Full time + Monday - Friday + No weekends no holidays **LOCATION** : + Springfield, MA The Licensed Practical ... Nurse (LPN) functions under the supervision and guidance of...support to the patient's primary care team regarding patients' utilization management needs. The Clinical Utilization Reviewer… more
- Elevance Health (Woburn, MA)
- Nurse Audit Lead - Carelon Payment Integrity **Location:** The ideal candidate will live within 50 miles of one of our pulse point locations and will work on a ... is determined to recover, eliminate, and prevent unnecessary medical-expense spending. The ** Nurse Audit Lead** is responsible for leading a team of clinicians… more
- Beth Israel Lahey Health (Cambridge, MA)
- …a job, you're making a difference in people's lives.** Registered Nurse - Emergency Department **Job Description:** **Primary Responsibilities** 1. The emergency ... nurse initiates accurate and ongoing assessment of physical, psychological...subjective and objective data through history taking, physical examination, review of records and communication with health care providers,… more
- Fallon Health (Worcester, MA)
- …in the region. **Responsibilities** **R** **esponsibility Summary:** Serves as a float Nurse Practitioner (NP) to each of the Summit ElderCare sites throughout ... documentation of all services provided according to professional + Identifies utilization and service delivery problems and participates in their + Participates… more
- Prime Therapeutics (Boston, MA)
- …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing criteria. + At minimum ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… more
- Baystate Health (Springfield, MA)
- …facility/program, emergency room, or from a skilled nursing facility. Responsible to review the discharge summaries, follow up on testing that is pending, ensure ... required and is vital. Care management program metrics including, emergency room utilization , and hospital admission/readmission data will be reviewed on a regular… more
- Cambridge Health Alliance (Cambridge, MA)
- …team leader in multi-disciplinary team discussion regarding treatment planning, treatment review , quality assurance and utilization review ... Nurse Practitioner - Clinical Specialist II (APRN), Psychiatry...authorizing practice in an expanded role as a Psychiatric Nurse Clinical Specialist and authorization including prescriptive authority. _In… more
- Fallon Health (Lowell, MA)
- …of all services provided according to professional standards + Identifies utilization and service delivery problems and participates in identifying a resolution ... activities including but not limited to record reviews, outcome measurement and review /revision of policies and procedures + Provides education and training to… more
- Beth Israel Lahey Health (Danvers, MA)
- …application of Quality Assurance and Customer Service Programs, implementation of Utilization Review mechanisms; structuring clinical supervision; provision of ... $7500 (prorated for part-time)** + **Day 1 Benefits!** The Nurse Manager is responsible for the management of the...the most pivotal stages in the recovery process. **The Nurse Manager's Responsibilities are:** + Plans, organizes, directs, and… more
- Edward M. Kennedy Community Health Center, Inc. (Worcester, MA)
- …engagement in self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and provides ongoing ... point-of-care testing, treatments, and lab and diagnostic test result review + Documents patient care, ongoing evaluation, patient progress/risk status,… more
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …engagement in self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and provides ongoing ... point-of-care testing, treatments, and lab and diagnostic test result review + Provides timely and informed patient triage +...shifts on a rotating basis. Required Qualifications: + Registered Nurse License in MA + Bachelor's degree in Nursing… more
- Fresenius Medical Center (Webster, MA)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Fresenius Medical Center (Northampton, 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
- Bear Mountain Health Care (Lowell, MA)
- …+ Meetings: Attending various meetings, including Morning Clinical Meeting, Utilization Review , At-Risk/Behavior Meeting, and QAPI (Quality Assurance ... and Performance Improvement). Qualifications: + Prior experience as an Assessment Coordinator or similar role in a long-term care facility. + Strong knowledge of UDA and MDS assessments. + Proficient in medical documentation and record-keeping. + Excellent… more