- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is ... timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring… more
- Molina Healthcare (Boston, MA)
- …and electronic medical record (EMR) experience. Preferred Qualifications * Experience as a registered nurse or nurse practitioner in a home health, ... post-discharge coordination to reduce hospital readmission rates and emergency room utilization . * Performs face-to-face in-person visits in a variety of settings… more
- Commonwealth Care Alliance (Boston, MA)
- …(must have): - Meaningful clinical experience including: - 3+ years' experience as a Registered Nurse in a high-touch clinical environment or home care, OR - ... role. Supervision Exercised: - Assumes responsibility for all nursing ( RN , LPN) and MA roles in the practice. 10...management team, shared accountability for reductions in acute care utilization - Attend team meetings and huddles to provide… more
- Cognizant (Boston, MA)
- …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification,… more
- Fenway Health (Boston, MA)
- …MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing Job Type Full-time Description As a Registered Nurse ( RN ) at Fenway Health ... patient, and other care team members. + Influences appropriate utilization of healthcare resources by helping to coordinate patient...+ Education: Associate degree in nursing + Current Massachusetts Registered Nurse ( RN ) license degree… more
- Commonwealth Care Alliance (Boston, MA)
- …complexities that require intensive care management and care delivery. Within the CIC Program, the Registered Nurse ( RN ) serves as an integral member of an ... and based on the fluctuating needs of the defined panel of members, the Registered Nurse will engage in regular assessments, visits at regularly scheduled… more
- State of Massachusetts (Marlborough, MA)
- The Massachusetts Department of Public Health (DPH) is seeking a Registered Nurse ( RN ) dedicated to public health, quality of life and safety to conduct ... in order to determine the degree of acceptance and utilization of health care, type and breadth of service,...requires a current and valid Massachusetts license as a Registered Nurse ( RN ) and valid… more
- CVS Health (Woonsocket, RI)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Atrius Health (Boston, MA)
- …health and welfare benefit package. **Job:** **Nursing* **Organization:** **Endocrinology* **Title:** * Registered Nurse (MNA) Endocrinology - Kenmore - Part time ... *SUMMARY * Under the direction of the Department Chief, Nurse Leader or designee, this registered professional...specialty. *EXPERIENCE* Strongly prefer minimum of 2 years of RN experience, ideally in an ambulatory care or Endocrine… more
- Atrius Health (Dedham, MA)
- …and welfare benefit package. **Job:** **Nursing* **Organization:** **Internal Medicine* **Title:** * Registered Nurse (MNA) Internal Medicine - Dedham - Full ... *SUMMARY * Under the direction of the Department Chief, Nurse Leader or designee, this registered professional...specialty. *EXPERIENCE* Strongly prefer minimum of 2 years of RN experience. Experience with an electronic medical records system… more
- Atrius Health (Dedham, MA)
- …and welfare benefit package. **Job:** **Nursing* **Organization:** **Internal Medicine* **Title:** * Registered Nurse (MNA) Internal Medicine - Dedham - 40HRS* ... *SUMMARY * Under the direction of the Department Chief, Nurse Leader or designee, this registered professional...specialty. *EXPERIENCE* Strongly prefer minimum of 2 years of RN experience. Experience with an electronic medical records system… more
- Atrius Health (Dedham, MA)
- …and welfare benefit package. **Job:** **Nursing* **Organization:** **Internal Medicine* **Title:** * Registered Nurse (MNA) Internal Medicine - Dedham - Full ... *SUMMARY * Under the direction of the Department Chief, Nurse Leader or designee, this registered professional...specialty. *EXPERIENCE* Strongly prefer minimum of 2 years of RN experience. Experience with an electronic medical records system… more
- Humana (Providence, RI)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...Greater than one year of clinical experience in a RN role in acute care setting with preference for… more
- CVS Health (Woonsocket, RI)
- …do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** utilizes clinical ... to coordinate, document, and communicate all aspects of the utilization /benefit management program. **Job Duties include (but are not...Time Zone. + Must have an active and unrestricted RN ( _Registered Nurse_ ) licensure in the state… more
- CVS Health (Woonsocket, RI)
- …shift times are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence required. + Minimum ... solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team.… more
- CVS Health (Woonsocket, RI)
- …health. + Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in clinically… more
- Fallon Health (Worcester, MA)
- …related field preferred **License** : Active, unrestricted license as a Registered Nurse in Massachusetts **Certification:** Certification in Case Management ... * A minimum of two years' clinical experience as a licensed Registered Nurse managing/coordinating/facilitating/providing care for member populations required *… more
- Sharecare (Boston, MA)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …require evening, weekend and/or holiday shifts on a rotating basis. Required Qualifications: + Registered Nurse License in MA + Bachelor's degree in Nursing from ... are currently hiring a Clinical Care Manager - OBAT RN based in Framingham. As part of a team-based...self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and… more
- BAYADA Home Health Care (Canton, MA)
- …in Senior Living communities **_._** Are you a solutions-oriented, team-focused ** Registered Nurse or Therapist (Physical Therapist, Physical Therapist ... inspire professional growth. **Qualifications:** + Current MA licensure as a Registered Nurse , Physical Therapist, Physical Therapy Assistant, Occupational… more
