- 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 (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
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare… more
- State of Massachusetts (Fall River, MA)
- …Mental Health center is seeking dedicated and compassionate individuals for the position of Registered Nurse IV who desire a rewarding career making a difference ... Inpatient Unit by meeting at least monthly with each RN to review work performance, recommend corrective...years of full-time, or equivalent part-time, experience as a registered nurse in a recognized hospital, clinic… 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
- 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
- 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
- Sedgwick (Providence, RI)
- …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
- CVS Health (Providence, RI)
- …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 (Providence, RI)
- …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
- Cardinal Health (Providence, RI)
- …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