- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring… more
- CenterWell (Boston, MA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… 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 ... necessity of the hospital care. Using the concepts of utilization review, clinical documentation improvement and revenue...in a clear and concise manner to the medical, clinical , and management staff. 12. Applies diplomacy… more
- Evolent (Boston, MA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Fresenius Medical Center (Lowell, MA)
- …requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory ... and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions...the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member… more
- Fresenius Medical Center (Lowell, MA)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Elevance Health (Woburn, MA)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... ** Nurse Reviewer I** **Virtual:** This role enables associates...required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
- Fenway Health (Boston, MA)
- …patient-centeredness, non-judgmental, harm reduction, behavioral health integration, and team-based care. The nurse serves in a clinical leadership role to the ... Registered Nurse , Per Diem Boston, MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing...care team with primary responsibilities for disease management , care coordination, and advice/triage needs for the care… more
- Beth Israel Lahey Health (Cambridge, MA)
- …completed). **KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED** 1. RN with experience in risk management , quality assessment, or utilization management . 2. Strong ... reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review...clinical abstracts, identifies quality of care and risk management issues. Uses clinical knowledge to assess… more
- Lawrence General Hospital (Lawrence, MA)
- …appropriate discharge plans. + Works in conjunction with Utilization Review Nurse , Social Worker and Clinical Care Leader to ensure all appropriate ... care setting with discharge planning, continuing care, care management , and utilization review. + Five years clinical nursing experience required +… more
- Atrius Health (Chelmsford, MA)
- …of the Department Chief, Nurse Leader or designee, this registered professional nurse provides practice support to a clinical team, recognizing the patient ... across the lifespan. This position is responsible for effective care delivery and management of patient care within a specialty, utilizing the nursing process and… more
- Atrius Health (Boston, MA)
- …of the Department Chief, Nurse Leader or designee, this registered professional nurse provides practice support to a clinical team, recognizing the patient ... across the lifespan. This position is responsible for effective care delivery and management of patient care within a specialty, utilizing the nursing process and… more
- Beth Israel Lahey Health (Boston, MA)
- …focusing on the delivery of efficient, high-quality care. This position ensures the appropriate utilization of clinical resources with a goal of a safe and ... quality indicators such as avoidable delays, length of stay, resource utilization , patient satisfaction, patient flow, outlier management , and readmissions… more
- Tufts Medicine (Melrose, MA)
- …in developing and maintaining an infrastructure for the systematic review and management of complex patients. The position will work closely with PHO medical ... to review patient records, analyze data, and identify practice and patient outlier utilization , and gaps in quality measures for weekly practice and medical director… more
- Beth Israel Lahey Health (Cambridge, MA)
- …with Harvard Medical School. The Inpatient Case Manager (CM) performs utilization reviews and coordinates discharge planning for MAH inpatient admissions. Inpatient ... Case Manager Guidelines and audit tool. Reports to Inpatient Case Management Supervisor. **Job Description:** **Essential Duties & Responsibilities (including but… more
- Lawrence General Hospital (Methuen, MA)
- …for this advanced degree) ? Current Massachusetts Nursing license ? Minimum 5 years clinical nursing experience ? 5 years case management experience in an acute ... hospital and being held accountable for appropriate financial and clinical outcomes of these patients. The RN Care Coordinator...care setting with discharge planning, continuing care, care management , and utilization review preferred. ? Strong… more
- Lawrence General Hospital (Methuen, MA)
- …Master's degree preferred + Current Massachusetts Nursing license + Minimum 5 years clinical nursing experience + 5 years case management experience in an ... acute care setting with discharge planning, continuing care, care management , and utilization review preferred. + Strong verbal and written communications skills… 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
- Tufts Medicine (Lowell, MA)
- …to weekend clinical and administrative staff. + Provides the direct management of the Weekend clinical staff, schedulers, intake supervisor and Weekend ... State and federal home health regulations. Responsible for the management of cost effective, efficient care to home health...regarding pre and post weekend follow-up. + Promotes efficient utilization of resources to achieve desired clinical … more
- Tufts Medicine (Lowell, MA)
- … such as interviewing, hiring, and disciplinary action. + Promotes efficient utilization of resources to achieve desired clinical outcomes and within ... with agency policy, State and federal home health regulations. Responsible for the management of cost effective, efficient care to home health patients ensuring the… more
