- 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
- 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
- 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
- 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
- Lincoln Financial (Boston, MA)
- …Care, Orthopedics, Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… 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
- Brockton Hospital (Brockton, MA)
- … management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience ... delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare… 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
- WTW (Boston, MA)
- …reviewed including master templates and client specific responses + Collaborate with health management senior reviewer and Project Manager to conduct follow up ... + Health analytics experience preferred + Understanding of health plan utilization /case management processes, network management , credentialing, quality… more
- Beth Israel Lahey Health (Boston, MA)
- …daily schedule to expedite surgical cases or personnel. Works in collaboration with the Nurse in Charge and Anesthesia, but is ultimately responsible to the OR ... Nurse Manager. **Job Description:** PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:...during which hours, the substitution of cases and the utilization of specific rooms for specific cases. + Assures… more
- Molina Healthcare (Boston, MA)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... including 3 or more years in one or more of the following areas: utilization management , case management , care transition and/or disease management… 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...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- Children's Hospital Boston (Boston, MA)
- …concurrent review process for acute psychiatric care + Possessing experience in Utilization Management / Utilization Review + Demonstrating the ability ... + Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current Massachusetts license… 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
- Beth Israel Lahey Health (Burlington, MA)
- …System Coordinators in par level establishment and maintenance, refill process, utilization analysis and product management . -Collaborates with Purchasing Agent ... provide a detailed monthly report on any overage. 3) Review /modify min/max inventory levels. 4) Audits inventory levels not...non-Pyxis product 12) Audits daily case equipment and supply utilization sheets to ensure accuracy of billing activity as… more
- State of Massachusetts (Wrentham, MA)
- …responsible for but not limited to, maintaining safe nursing staffing patterns, utilization and deployment of staffing resources, management of budgets, overtime ... seeking a dynamic, caring, mission-driven nursing professional with excellent organizational, management and leadership skills for the critical position of Director… more