- Humana (Boston, MA)
- …of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and independent ... guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and… more
- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is ... and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets… more
- Beth Israel Lahey Health (Plymouth, MA)
- …years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the ... severity of an array illnesses, intensity of service, and care coordination needs + Ability to identify appropriateness of patients admission and level of care needs (inpatient & observation) utilizing Interqual criteria + Knowledge of Interqual required;… more
- CVS Health (Boston, MA)
- …opportunities to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal and external ... constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with productivity and… 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 Clinic inpatient… more
- Beth Israel Lahey Health (Plymouth, MA)
- …years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the ... severity of an array illnesses, intensity of service, and care coordination needs + Ability to identify appropriateness of patients admission and level of care needs (inpatient & observation) utilizing Interqual criteria + Knowledged of Interqual required;… more
- Commonwealth Care Alliance (Boston, MA)
- …is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA)...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… 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 the ... flexibility of a home-based office. As the AVP of Utilization Review & Pharmacy, you will lead and direct...of experience in the Nursing areaAND + Registered Professional Nurse license in residential area and in operational national/local… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for determining ... with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities for improvement… more
- Humana (Boston, MA)
- …part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds strategies ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid is… more
- State of Massachusetts (Boston, MA)
- …Massachusetts Department of Public Health (DPH), is seeking a skilled Screening Nurse Liaison to oversee patient admissions. This role involves assessing prospective ... smooth transitions into the facility. Acting as the primary liaison, the nurse will collaborate with case managers, social workers, physicians, and professional… more
- Fenway Health (Boston, MA)
- Registered Nurse , Part-Time Boston, MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing Job Type Part-time Description As a Registered ... Nurse (RN) at Fenway Health you will provide compassionate,...patient, and other care team members. + Influences appropriate utilization of healthcare resources by helping to coordinate patient… more
- Evolent (Boston, MA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part of ... focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and procedures… more
- Atrius Health (Braintree, MA)
- …value-based care system in the country. *_SUMMARY_*__ Physician Assistant/ Nurse Practitioner (MNA) position supporting our Orthopedics department. The Physician ... Assistant/ Nurse Practitioner will work collaboratively on a team to...care in Specialty. Demonstrated excellence in practice, documentation and utilization . Maintain high patient satisfaction. Ability to work effectively… more
- Atrius Health (Weymouth, MA)
- …the direction of the department chief, the incumbent is a certified Nurse Practitioner (NP) or Physician Assistant (PA) who possesses advanced training/skills in ... Serves as a patient educator in areas of specialization. *_EDUCATION/LICENSES/CERTIFICATIONS_* * Nurse Practitioner (NP) *- Must be nationally certified as an FNP… more
- Brockton Hospital (Brockton, MA)
- Registered Nurse (RN), Part-Time Flex Evenings, Emergency Signature Healthcare's Brockton Hospital is hiring for a Part-Time Flex Evenings Registered Nurse (RN) ... commitment to comprehensive patient care. Under the guidance of a Charge nurse , our team emphasizes efficient throughput, flexibility, and autonomy in initiating… more
- Brockton Hospital (Brockton, MA)
- Periop-101/Transition to Practice OR Nurse Signature Healthcare's Brockton Hospital is hiring Full time Registered Nurse (RN)'s for a Periop-101/Transition to ... will be required to fulfill call requirements with a 30-minute response time. Registered Nurse (RN) Roles and Responsibilities: Specific Duties: + The Nurse will… more
- Atrius Health (Weymouth, MA)
- …the country. *SUMMARY* Under the direction and supervision of a Department Chief, Nurse Leader or designee, this licensed practical nurse provides direct patient ... practical nursing. Possess a current license to practice as a practical nurse in the Commonwealth of Massachusetts.American Heart Association Basic Life Support… more
- Brockton Hospital (Brockton, MA)
- Registered Nurse (RN), Part- Time Flex Evening, A2-Telemetry Signature Healthcare's Brockton Hospital is hiring for a Part Time Flex Registered Nurse (RN) for ... off-shifts to enhance patient care, staffing, and throughput coordination. Registered Nurse (RN) Roles and Responsibilities: + Assessment: collects relevant patient… more
- Brockton Hospital (Brockton, MA)
- Registered Nurse (RN), Part-Time Flex, 8-hour Evening Shift, A3 Medical-Surgical Unit Signature Healthcare's Brockton Hospital is hiring for a Part-Time Flex, 8-hour ... Evening Shift Registered Nurse (RN) for the A3 Medical-Surgical Unit in Brockton,...+ Research: uses clinical inquiry in practice + Resource Utilization : considers factors related to safety, effectiveness and cost… more