- VitalCore Health Strategies (Hopkinton, MA)
- …Animal/Pet Insurance Employee Assistance Program and Discount Center 401K EEO Keywords: Utilization Management , RN , Nurse , Administrative, #INDMA ... in Correctional Healthcare, has a Full-Time opening for a Utilization Management RN at the...of an accredited School of Nursing Licensure as a Registered Nurse in the state of employment… more
- CVS Health (Woonsocket, RI)
- …active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, ... all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and...**Required Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care… more
- CenterWell (Boston, MA)
- … RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous… more
- Beth Israel Lahey Health (Cambridge, MA)
- …SKILLS, AND ABILITIES REQUIRED** 1. RN with experience in risk management , quality assessment, or utilization management . 2. Strong spreadsheet, ... Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported...on the key performance indicators and quality measures, the RN specialist also aims to foster a culture of… more
- Beth Israel Lahey Health (Burlington, MA)
- …weekends. This position is on-site at Lahey Hospital and Medical Center. The Utilization Analyst works with physicians, the payers and inpatient case management ... medical necessity of the hospital care. Using the concepts of utilization review, clinical documentation improvement and revenue integrity, these specialized case… more
- Massachusetts Institute of Technology (Cambridge, MA)
- Registered Nurse , Care Coordinator + Job Number: 25320 + Functional Area: Health Care + Department: MIT Health + School Area: Executive Vice President + Pay ... + Schedule: + Pay Grade: 9 Email a Friend Save Save Apply Now Posting Description REGISTERED NURSE , CARE COORDINATOR, MIT Health, will serve as a core member of… more
- Beth Israel Lahey Health (Burlington, MA)
- …to meet the needs of the department. **Minimum Qualifications:** Education: * Registered Nurse , Bachelors Degree or commensurate experience preferred. Licensure, ... Must hold current Commonwealth of Massachusetts license as a Registered Nurse , and Basic Life Support (BLS)...of medical/surgical nursing care experience. Two years of case management or utilization management experience… more
- Fallon Health (Worcester, MA)
- … Nurse in a clinical setting required. * 2 years' experience as a Utilization Management /Prior Authorization nurse in a managed care payer preferred. * ... degree in nursing required **License/Certifications:** Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience:** * A minimum of… more
- Fresenius Medical Center (Medford, MA)
- …staff training, equipment, physician and patient relations, cost containment, supply management , medical records, patient billing, OSHA and all company, state and ... by working with the Vice President of Quality and other organization management to ensure that organization/ASC policies and procedures are followed. + Responsible… more
- Fenway Health (Boston, MA)
- …MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing Job Type Full-time Description As a Registered Nurse ( RN ) at Fenway Health ... to the care team with primary responsibilities for disease management , care coordination, and advice/triage needs for the care...+ Education: Associate degree in nursing + Current Massachusetts Registered Nurse ( RN ) license degree… more
- Beth Israel Lahey Health (Needham, MA)
- …practice model. **Job Description:** **Essential Responsibilities:** 1. Performs utilization management , care coordination, and discharge planning ... 40 hr (every third weekend & rotating holiday required) Job Summary: The RN Case Manager (CM) facilitates the coordination of care for those patients admitted… more
- Beth Israel Lahey Health (Boston, MA)
- …quality indicators such as avoidable delays, length of stay, resource utilization , patient satisfaction, patient flow, outlier management , and readmissions ... job, you're making a difference in people's lives.** The RN Case Manager working in the Triad Model of...of efficient, high-quality care. This position ensures the appropriate utilization of clinical resources with a goal of a… more
- Atrius Health (Dedham, MA)
- …and welfare benefit package. **Job:** **Nursing* **Organization:** **Internal Medicine* **Title:** * Registered Nurse (MNA) Internal Medicine - Dedham - Full ... *SUMMARY * Under the direction of the Department Chief, Nurse Leader or designee, this registered professional...This position is responsible for effective care delivery and management of patient care within a specialty, utilizing the… more
- Point32Health (Canton, MA)
- …with the interdisciplinary care team, to improve member outcomes (ie, Utilization Management , Medical Director, pharmacy, community health workers, dementia ... Qualifications - what you need to perform the job Certification and Licensure + Registered Nurse with current unrestricted license in state of residence + May… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. * Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management * Serve as the primary relationship manager and point of contact… more
- Intermountain Health (Boston, MA)
- …of Intermountain Health, and abide by service behavior standards. **Minimum Qualifications** + Current Registered Nurse ( RN ) license in state of practice. + ... **Job Description:** The RN Ambulatory Care Manager I delivers comprehensive ambulatory... Management Certification + Demonstrated experience in case management , utilization review, or discharge planning. +… more
- Commonwealth Care Alliance (Boston, MA)
- …delegated partnerships programs, working with clinical community partners responsible for care management and utilization management across CCA's One Care ... & Language (nice to have): * Familiarity with care management and utilization management systems...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- Highmark Health (Boston, MA)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- Elevance Health (Boston, MA)
- …facility-based and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience; or any combination of education and ... + Supporting frontline staffing, coaching, mentoring through 1:1s and Performance management . + Partnering with Quality and Training teams. + Attending meetings… more
- Commonwealth Care Alliance (Boston, MA)
- …and provider relationship management tools. * Understanding of claims operations, utilization management , and quality programs as they relate to provider ... engagement, delegation partnerships, provider services, contracting, quality, compliance, medical management , and analytics teams to advance provider network operations,… more
