- 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
- Beth Israel Lahey Health (Burlington, MA)
- …difference in people's lives.** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse (RN), Massachusetts + Three years of recent clinical… 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 ... Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality assurance for Lahey… 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 ... of Public Health (DPH), is seeking a skilled Screening Nurse Liaison to oversee patient admissions. This role involves...ensuring access for special populations./ * /Prepare reports for utilization review and census meetings./ * /Assist… more
- Sharecare (Boston, MA)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is ... To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and objectives of the… 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
- Lincoln Financial (Boston, MA)
- …Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like to work here?** At ... 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
- Evolent (Boston, MA)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... 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 by adhering to company… more
- Highmark Health (Boston, MA)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… 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
- 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 ... time, 40 hours per week. Job Profile Summary Provides assessment, screening and ongoing review of the clinical course to all patients who are referred to the case… 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...of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's… more
- Beth Israel Lahey Health (Burlington, MA)
- …and in conjunction with the appropriate clinical personnel, (ie department nurse manager or clinical manager), coordinates and manages the procurement of ... the Supply Chain Coordinator will assure supply availability and efficient utilization of supply resources. Essential Duties & Responsibilities including but not… more
- East Boston Neighborhood Health Center (East Boston, MA)
- …range planning and determining staffing needs. + Assists Home Care Manager/Residential Nurse manager to monitor utilization and processes for stocking Nursing ... in policy review and revision. Works with Home Care Director/Residential Nurse Manager to update policies, procedures and workflows as needed to ensure… 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 ... indicators/benchmarking such as Falls, Pressure Ulcers, Medication Errors, Restraint Utilization , Re-hospitalization, Anti-psychotic utilization , ADL splits/documentation, etc.… more
- Highmark Health (Boston, MA)
- …regulatory requirements. Document, process and route requests for services to the nurse reviewer and other departments based on documentation procedures, including ... review type, clinical information, and decision timeframes. Follow policies...and notification requirements are met + Communicate effectively with Utilization Management Staff, providers, other internal and external customers… more
- Fresenius Medical Center (Waltham, MA)
- …guidelines as mandated by Medicare. + Assures the correct setup and utilization of billing software (Advantx/Medical Manager) and maintains system security and ... include; + Front Desk Coordinator, expectations established and controls set. + Nurse Manager, assuring proper chart documentation is established. + Physician, … more
- WTW (Boston, MA)
- …issues or impact to timeline proactively to Project Manager + Complete initial review of carrier responses for parity projects + Map carrier responses to appropriate ... a manner consistent with WTW work processes and peer review standards (eg, filing of drafts, deliverables, client and...Agency, Legal/Compliance Firm, or insurance company + US Registered Nurse or LCSW with active licensed preferred + Health… more
- Dana-Farber Cancer Institute (Boston, MA)
- …practitioner group consisting of physicians, physician's assistants, program nurses and nurse practitioners and other care providers, the individuals in this ... the assigned patient population to achieve patient safety, flow and resource utilization goals of the organization and sponsoring agencies; + Responsible for… more
- Evolent (Boston, MA)
- …years of direct clinical patient care + **Minimum one year of experience with Utilization Review (UM) in a managed care environment** + **Cardiology and Oncology ... + Performs other duties as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of three… more