- Humana (Concord, NH)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Concord, NH)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CenterWell (Concord, NH)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Concord, NH)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Concord, NH)
- …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 and… more
- CenterWell (Concord, NH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...volume and fast paced environment + Previous experience in utilization management + Education: BSN or bachelor's… more
- Humana (Concord, NH)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Sharecare (Concord, NH)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Veterans Affairs, Veterans Health Administration (Manchester, NH)
- …EDRP application. Former EDRP participants ineligible to apply. Responsibilities This Registered Nurse - Community Living Center (CLC) is located in the Long Term ... education, orientation, competencies, and providing quality improvement and outcomes utilization consultation. - Demonstrates leadership in delivering and improving… more
- Humana (Concord, NH)
- …experience in an acute care, skilled or rehabilitation setting, home health, DME, triage, utilization , or case management . + **Ability to work ANY 8-hour shift ... caring community and help us put health first** The Nurse Advice Line is a fast-paced inbound call center...+ Bachelor's degree in nursing (BSN) + Previous case management , utilization review, or triage experience +… more
- Lawrence General Hospital (Lawrence, MA)
- …referrals and facilitates appropriate discharge plans. + Works in conjunction with Utilization Review Nurse , Social Worker and Clinical Care Leader to ... experience in an acute care setting with discharge planning, continuing care, care management , and utilization review. + Five years clinical nursing experience… more
- Tufts Medicine (Lowell, MA)
- …productivity and utilization of all resources. The ED Clinical Resource Nurse utilizes the nursing process, leadership skills and current evidence based clinical ... Lowell General Hospital is seeking an **ED Clinical Resource Nurse .** The ED Clinical Resource Nurse is...specific needs of groups or individuals and work with education/ management to address those needs in a timely manner… more
- Beth Israel Lahey Health (Exeter, NH)
- Registered Nurse Case Manager + Full Time + Exeter, NH 03833 ... one weekend per month (may change), alternating holiday rotation The Nurse Case Manager/Discharge Planner collaborates, facilitates and negotiates the delivery of… more
- Highmark Health (Concord, NH)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Beth Israel Lahey Health (Exeter, NH)
- Clinical Resource Nurse + Part Time + Exeter, NH 03833 (https://maps.google.com/maps?q=Exeter%2C%20NH%20%2003833&zoom=14&size=512x512&maptype=roadmap&sensor=false) + ... 18 months of hire **Major Responsibilities:** 1. Assumes responsibility for clinical management functions on the assigned shift. 2. Models excellence in nursing… more
- Fresenius Medical Center (Lowell, MA)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Tufts Medicine (Lowell, MA)
- …Reporting to the Vice President of Patient Care Services and Chief Nurse Executive, this position has oversight of all clinical and administrative functions ... of the case management and social work departments in a four-time designated...programs of care. 11. Monitors and critically analyzes resource utilization of the unit. 12. Collaborates with physicians, hospital… more
- Datavant (Concord, NH)
- …function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in… more
- Highmark Health (Concord, NH)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- State of Massachusetts (Tewksbury, MA)
- …mental illness. The COO serves as a member of the Leadership and Senior Management Teams and will take the lead role in the overall planning, directing, ... and nutrition services, campus police, health information services, and facilities management . Given the critical nature of hospital infrastructure, expertise in… more