- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Humana (Boston, MA)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical...Skilled nursing facility experience and /or skilled nursing facility utilization management review experience. +… more
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible ... reports to the Director of Utilization Management * Oversees clinical decision review for...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- Beth Israel Lahey Health (Burlington, MA)
- …you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered ... the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg… more
- Zurich NA (Boston, MA)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review , catastrophic or disability experience + 5 ... AVP, Utilization Review & Pharmacy 123092 Zurich...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities… more
- Evolent (Boston, MA)
- …appeals. **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review as an LPN or LVN is required. + Must ... team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies 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 ... for complex admissions, ensuring access for special populations./ * /Prepare reports for utilization review and census meetings./ * /Assist the CEO with public… more
- Veterans Affairs, Veterans Health Administration (Manchester, NH)
- …Possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... Summary This Registered Nurse - Clinical Nurse Coordinator position is...of VHA guidelines and current evidence-based standards of care Utilization Review NOTE: Grandfathering Provision - All… more
- HCA Healthcare (Manchester, NH)
- …in Nursing preferred. Experience: Minimum of two years' experience in case management and/or utilization management preferred, or relevant professional ... designated shift. In collaboration with other members of the management team, the CNC directs, monitors, and evaluates nursing...you, we encourage you to apply for our Clin Nurse Coord opening. Our team will promptly review… more
- HCA Healthcare (Derry, NH)
- …**Job Summary and Qualifications** The Case Manager's primary duties are to provide Utilization Review and Case Management functions for the ... encourage you to apply for our RN Case Manager Registered Nurse PRN opening. We review all applications. Qualified candidates will be contacted for interviews.… more
- HCA Healthcare (Manchester, NH)
- …in Nursing preferred. Experience: Minimum of two years' experience in case management and/or utilization management preferred, or relevant professional ... designated shift. In collaboration with other members of the management team, the CNC directs, monitors, and evaluates nursing...path, we encourage you to apply for our Clin Nurse Coord opening. We review all applications.… more
- Sharecare (Boston, MA)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- Beth Israel Lahey Health (Wakefield, MA)
- …system considered in lieu of degree. + Active, unrestricted Massachusetts Registered Nurse License required. Certification in Case Management (CCM) preferred. NH ... making a difference in people's lives.** The Care Manager, RN provides care management services to the BILHPN primary care physicians focusing on at risk, high… more
- Beth Israel Lahey Health (Wakefield, MA)
- …system considered in lieu of degree + Active, unrestricted Massachusetts Registered Nurse License required. Certification in Case Management (CCM) preferred. NH ... of population health and is responsible to ensure that quality, efficient care management services are provided to the BILHPN provider's risk populations. The Care… more
- Evolent (Boston, MA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management … more
- Highmark Health (Boston, MA)
- …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or… 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...to nursing policy and procedure. + Communicate effectively with management , peers, and health team members. + Interact effectively… more
- Commonwealth Care Alliance (Boston, MA)
- …is strongly preferred. + Experience in Medicaid/Medicare grievances and appeals and/or Utilization Review is strongly preferred. **Required Knowledge, Skills & ... and summarizes medical information for medical director, consultants, and other external review . + Prepares recommendations to either uphold or deny appeal and… more
- Tufts Medicine (Burlington, MA)
- …The position provides day to day support and oversight to Utilization Review departments and UM vendor management . The UM Operations Manager is responsible ... Utilization Review and Discharge Planning including implementation and annual review of the Utilization Management Plan and assisting with the… more