- Beth Israel Lahey Health (Plymouth, MA)
- …using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- Humana (Boston, MA)
- …skills to make an impact** **Required Qualifications** + Compact licensure + Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary ... of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and independent… more
- Beth Israel Lahey Health (Burlington, MA)
- …people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse (RN) Case Manager for ... Clinic inpatient admissions. Leads the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case… more
- Zurich NA (Boston, MA)
- AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is seeking an AVP, Utilization Review & Pharmacy. This is a fully remote position, offering ... flexibility of a home-based office. As the AVP of Utilization Review & Pharmacy, you will lead...more years of experience in the Nursing areaAND + Registered Professional Nurse license in residential area… more
- Beth Israel Lahey Health (Burlington, MA)
- …collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities ... Duties & Responsibilities** _including but not limited to:_ + Ensures that Utilization Review nurses are consistently recommending the appropriate admission… more
- Sharecare (Boston, MA)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and… more
- Beth Israel Lahey Health (Wakefield, MA)
- …care system considered in lieu of degree + Active, unrestricted Massachusetts Registered Nurse License required. Certification in Case Management (CCM) ... Working with the healthcare team, the Care Manager, RN monitors appropriate utilization of healthcare resources, promotes quality and efficiency by developing 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 ... ensuring access for special populations./ * /Prepare reports for utilization review and census meetings./ * /Assist...years of full-time, or equivalent part-time, experience as a registered nurse in a recognized hospital, clinic… more
- Beth Israel Lahey Health (Wakefield, MA)
- …care system considered in lieu of degree. + Active, unrestricted Massachusetts Registered Nurse License required. Certification in Case Management (CCM) ... Working with the healthcare team, the Care Manager, RN monitors appropriate utilization of healthcare resources, promotes quality and efficiency by developing and… more
- Brockton Hospital (Brockton, MA)
- …delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare ... primary responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It… more
- Tufts Medicine (Burlington, MA)
- …**Job Overview** The position provides day to day support and oversight to Utilization Review departments and UM vendor management. The UM Operations Manager ... is responsible for compliance with CMS Conditions of Participation regarding Utilization Review and Discharge Planning including implementation and annual … more
- Beth Israel Lahey Health (Plymouth, MA)
- …job that may reasonably be required._ **Education/Experience Required:** _Required_ + State of MA Registered Nurse (RN) + 3-5 years acute care nursing + Two ... 3) Decreasing unit cost, 4) reducing readmissions. **Duties/Responsibilities:** **A. Utilization Management** Performs review of anticipated admissions utilizing… more
- Molina Healthcare (Boston, MA)
- …identifying opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational ... performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity,... Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of RN license.… more
- Children's Hospital Boston (Boston, MA)
- … review process for acute psychiatric care + Possessing experience in Utilization Management/ Utilization Review + Demonstrating the ability to integrate ... Utilization Management) preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse (RN) + A certification as a Certified Case… 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 ... (skilled nursing, long term care, assisted living or hospital) is required. + Current Registered Nurse license for the state in which they operate. + Current… more
- State of Massachusetts (Wrentham, MA)
- …have at least (A) four years of full-time or equivalent part-time experience as a registered nurse in a recognized hospital, clinic, or medical facility and (B) ... from an approved school of nursing must have applied for the first available registered nurse examination. Based on assignment, possession of a current and valid… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …+ 1 year clinical and/or related experience required. + Case Management, Utilization Review , Oncology, Cellular Therapy and/or Prior Authorization experience is ... Effector Cell (IEC) therapies, including benefit verification, pre-certification, concurrent review , appeals, and preparation of cost estimates for insurance...preferred. + Licensed as a Registered Nurse in the Commonwealth of Massachusetts… more
- Brockton Hospital (Brockton, MA)
- …preferred. Must have current license from Commonwealth of Massachusetts to practice as a Registered Nurse . Minimum of five years clinical experience in an acute ... care facility required. Prior experience in case management, utilization review or discharge planning required. more
- WTW (Boston, MA)
- …Third Party Administrator, Regulatory Agency, Legal/Compliance Firm, or insurance company + US Registered Nurse or LCSW with active licensed preferred + Health ... issues or impact to timeline proactively to Project Manager + Complete initial review of carrier responses for parity projects + Map carrier responses to appropriate… more
- Tufts Medicine (Burlington, MA)
- …technology. **Job Description** **Minimum Qualifications:** 1. BSN degree 2. Licensed as a Registered Nurse 3. Five (5) years relevant experience in the ... with multiple revenue cycle and hospital departments, such as Coding, Utilization Management (UM), Case Management, Quality and Physician advisors and leaders.… more