- Beth Israel Lahey Health (Boston, MA)
- …people's lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...required and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse ( RN ), Massachusetts +… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in ... Weekend and holiday rotations required **Job Description:** The Inpatient Registered Nurse ( RN ) Case Manager...Leads the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review… more
- Beth Israel Lahey Health (Milton, MA)
- …people's lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...required and directed. Qualifications: Required . Licensure as a Registered Nurse ( RN ), Massachusetts .… more
- Beth Israel Lahey Health (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... and educate to improve outcomes. -Assists with preparation and presentation of utilization review monitoring/trending reports for review with physicians… more
- Cambridge Health Alliance (Cambridge, MA)
- …Center **Work Days:** Generally Mon-Fri days 8-4:30 and one evening/wk **Category:** Registered Nurse **Department:** Office Based Opioid Grant **Job Type:** ... OBOT RN Case Manager **Date Posted:** 01/16/2025 **Requisition Number:**...a business card. * Integrates the discharge planning/coordination and utilization review functions in the case management… more
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …require evening, weekend and/or holiday shifts on a rotating basis. Required Qualifications: + Registered Nurse License in MA + Bachelor's degree in Nursing from ... are currently hiring a Clinical Care Manager - OBAT RN based in Framingham. As part of a team-based...self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and… more
- Beth Israel Lahey Health (Cambridge, MA)
- …annually. c. Maintains BLS, ACLS certification d. Attends Emergency Department RN Competency Review Course annually. e. Attends hospital-based Education ... difference in people's lives.** Join our team as a key Emergency Department nurse in our renovated and expanded department, caring for approximately 34,000 patients… more
- Prime Healthcare (Woonsocket, RI)
- …is unable to meet the patient's care needs. The ICM is responsible for the utilization review process as it relates to triage and admission to the Behavioral ... ensure the achievement of quality, clinical and cost-effectiveness, and utilization of evidence-based quality practices. The ICM ensures the...EXPERIENCE, TRAINING 1. Maintains an active license as a Registered Nurse , LCSW, or LICSW in Rhode… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …+ 1 year of clinical and/or related experience required. Case Management, Utilization Review and/or Prior Authorization experience is preferred. + ... **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. **KNOWLEDGE, SKILLS, AND ABILITIES… more
- Commonwealth Care Alliance (Boston, MA)
- …claims adjudication, clinical coding reviews for claims, settlement, claims auditing and/or utilization review required + 7+ years experience with Optum Claims ... regulations. The role will also be responsible for timely review and research, as necessary on all new and...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- Sedgwick (Boston, MA)
- …Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Medicare Compliance **PRIMARY PURPOSE** **:** To provide professional assessment, ... clinical data; to complete complex submissions revisions/updates in preparation for Medicare review and act as an internal resource regarding Centers for Medicare &… more
- Beth Israel Lahey Health (Cambridge, MA)
- …for the overall operation of care transitions discharge planning and/or utilization management departments through oversight of daily and long-term activities at ... **Job Description:** **PLANNING:** Plans department's clinical services and operations including review of tracking and trending data to assess need for performance… more
- Beth Israel Lahey Health (Burlington, MA)
- …to the age of the patient Cares for patients as delegated by the provider, RN or LPN within scope of practice and competence. Contributes information provided by the ... plans since last appointment were followed and results are available for physician review Confirms that lab and other ancillary tests are performed and results… more
- CVS Health (Boston, MA)
- …visit, inpatient, skilled nursing, or rehabilitative stay. Under the direction of a Registered /Licensed RN , the TOC Coach ensures the member experiences a ... or changes in condition to be transitioned back to RN . + Complete post discharge call and required assessments...who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current… more
- Dana-Farber Cancer Institute (Boston, MA)
- …protocol under which the patient is treated. In conjunction with RN transplant coordinators, Cell Therapy Coordinators provide extensive direction to patients, ... the assigned patient population to achieve patient safety, flow and the resource utilization goals of the organization + Responsible for ensuring filing or reporting… more
- Sharecare (Boston, MA)
- …of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and cost-effective manner while ... orientation and to take the pre and post-test to review competency during orientation. Yearly competency test is required...will follow company policy to transfer call to an RN or appropriate colleague when member needs are outside… more
- Tufts Medicine (Boston, MA)
- …Support duties: Provides basic care services to patients, but does not have an RN or LPN license. Positions in this nursing support work under the direction of ... physicians, mid-level practitioners, and may work under the direction of registered nurses depending on their unit. A clinical technologist role that has specialized… more
- Cardinal Health (Boston, MA)
- …regarding best demonstrated practices + Significantly influences customer acceptance and utilization of new products and services in multi-site and/or complex ... of the time + Bachelor's degree preferred + Current RN license preferred + 6-8 years of experience in...other status protected by federal, state or local law._ _To read and review this privacy notice click_ here… more
- Commonwealth Care Alliance (Boston, MA)
- …administrative delays; that clients are invested in their constituents' adoption and utilization and share performance targets; and that instED has the widest window ... for the department based on the organization's strategic goals. Responsible to review and improve existing sales incentive plans to ensure alignment with sales… more
- Beth Israel Lahey Health (Woburn, MA)
- …the age of the patient D. Cares for patients as delegated by the provider, RN or LPN within scope of practice and competence. E. Contributes information provided by ... plans since last appointment were followed and results are available for physician review o Confirms that lab and other ancillary tests are performed and results… more