- Point32Health (Canton, MA)
- …leading, and modifying the business processes and operations for all levels of utilization management review (ie, Precertification and Intake Services, ... perform the job** **Education, Certification and Licensure** + Master's degree preferred. + RN ( Registered Nurse ) with unrestricted MA license preferred. +… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a key role in ensuring CCA ... services, procedures, and facilities under the provisions of CCA's benefits plan. The Utilization Management (UM) Reviewer is responsible for day-to-day… more
- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer is...**What You'll Be Doing:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer is...**What You'll Be Doing:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Beth Israel Lahey Health (Burlington, MA)
- …people's lives.** The inpatient Case Manager assigned by nursing unit coordinates utilization review , discharge planning and monitors quality assurance for Lahey ... **Essential Duties & Responsibilities including but not limited to:** 1) Performs utilization review and discharge planning to inpatient admissions. 2) Applies… more
- WTW (Boston, MA)
- …compliance experience may also be considered + Understanding of health plan utilization /case management processes, network management , credentialing, quality ... to timeline proactively to Project Manager + Complete initial review of carrier responses for parity projects + Draft...and client specific responses + Collaborate with MHPAEA senior reviewer and Project Manager to conduct follow up calls/emails… more
- Fresenius Medical Center (Medford, MA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- …considered and referred as vacancies become available. This OCA may be used to fill a Registered Nurse ( RN ) position that is located in the one of following ... VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities VA offers a...CLC-2C CLC-62C CLC-62D CLC-78C The Community Living Center (CLC) Registered Nurse ( RN ) is responsible… more
- Beth Israel Lahey Health (Cambridge, MA)
- …Regular **Scheduled Hours:** 24 **Work Shift:** Rotating (United States of America) REGISTERED NURSE - EMERGENCY DEPARTMENT **Job Description:** REGISTERED ... annually. c. Maintains BLS, ACLS certification d. Attends Emergency Department RN Competency Review Course annually. e. Attends hospital-based Education… more
- Beth Israel Lahey Health (Boston, MA)
- …in a cost-effective and quality-driven manner. **Job Description:** **A. UTILIZATION MANAGEMENT ** : Perform a 100% review of anticipated admissions utilizing ... a difference in people's lives.** The role of the RN Case Manager Emergency Department (ED) is to increase...: Three years of acute care experience **Preferred:** Case Management or Utilization Management experience… more
- Highmark Health (Boston, MA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… 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...Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to Medical Assistant Treatment Program (MAT) patients. As… more
- Beth Israel Lahey Health (Cambridge, MA)
- …**Required Qualifications** 1. Bachelor's degree preferred. Current state license as a Registered Nurse , or LCSW/LICSW 2. Three years of medical/surgical nursing ... of care criteria and reports them to the physician reviewer . 6. Works with patients and families to facilitate...care experience. Two years of case management or utilization management experience.… 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 ... reviewed including master templates and client specific responses + Collaborate with health management senior reviewer and Project Manager to conduct follow up… more
- Tufts Medicine (Burlington, MA)
- …**Job Description** **Minimum Qualifications:** 1. Bachelor's Degree in Nursing 2. Active Registered Nurse ( RN ) license in Massachusetts or compact ... (ICU, ED, Critical Care, strong Med/Surg Specialty) or equivalent case management , utilization review , denials management , or progressive leadership… more
- Tufts Medicine (Tewksbury, MA)
- …etc.) **Job Description** **Minimum Qualifications:** 1. Bachelor's degree in Nursing (BSN). 2. Registered Nurse ( RN ) license. 3. Basic Life Support (BLS) ... expectations, continuing education, credentialing, performance appraisals, auditing, concurrent monitoring, utilization review , risk management and active… more
- Sedgwick (Boston, MA)
- …and consult review ; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review . **Skills & ... place to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and… more
- Elevance Health (Woburn, MA)
- …EST** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs ... **Telephonic Nurse Case Manager II** **Location: This is a...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Tufts Medicine (Burlington, MA)
- …**Job Description** **** **Minimum Qualifications:** 1. Associate's degree in Nursing 2. Active Registered Nurse ( RN ) license in Massachusetts or compact ... hospital setting (ICU, ED, Critical Care, strong Med/Surg Specialty) OR case management , utilization review , or denials management in an acute-care… more
- Prime Therapeutics (Boston, MA)
- …oversight for this program is provided by the Manager, Patient Programs. **Responsibilities** + Registered Nurse ( RN ). + 5 years of post-degree clinical ... experience. + Experience in managed care, specialty drugs, care management and utilization review . +...- Preferred: Bachelors - Nursing **Certifications** Certifications - Required: RN - Registered Nurse , State… more