- Beth Israel Lahey Health (Burlington, MA)
- …in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse ( RN ) Case ... a timely process. Registered Nurses (RNs) with utilization review experience, case management ...the needs of the department. **Minimum Qualifications:** Education: * Registered Nurse , Bachelors Degree or commensurate experience… more
- Tufts Medicine (Lowell, MA)
- …expectations, continuing education, credentialing, performance appraisals, auditing, concurrent monitoring, utilization review , risk management and active ... us? This is a great opportunity for an emerging RN leader to assist the ICU Clinical Manager with...Impella patients. The Clinical Leader of ICU-G is a Registered Nurse with responsibility and accountability for… more
- Highmark Health (Boston, MA)
- …Highmark Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... + Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN … more
- Humana (Boston, MA)
- …guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Active Licensed Registered Nurse ( RN ) in the state of Virginia or ... licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home… more
- Beth Israel Lahey Health (Cambridge, MA)
- …needs throughout the spectrum of life, from pediatrics to older adults. **Job Description:** Registered Nurse - Sign on Bonus eligibility up to $12,000 **Primary ... lives.** Join our team as a key Emergency Department nurse in our renovated and expanded department, caring for...c. Maintains BLS, ACLS certification d. Attends Emergency Department RN Competency Review Course annually. e. Attends… more
- Children's Hospital Boston (Boston, MA)
- …Hours per Week:40 Job Posting Category:NursingJob Posting Description:The Utilization Review Nurse will be ... responsible for: + Completing Utilization Management Clinical Reviews including: reviewing hospital admissions and continued inpatient stays to assess… more
- Beth Israel Lahey Health (Burlington, MA)
- …a difference in people's lives.** 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)
- …Weekend Rotation **Job Description:** 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
- Humana (Boston, MA)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to ... of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines… more
- Beth Israel Lahey Health (Newburyport, MA)
- …of relevant nursing experience in the acute care setting and previous case management experience, utilization review and/or discharge planning experience is ... facilitator of the discharge plan is accountable and responsible for the utilization management , continuing evaluation and implementation of discharge planning… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Conduct pre-certification, concurrent, and retrospective reviews with emphasis on utilization management , discharge planning, care coordination, clinical ... well as regulatory and NCQA requirements. + Refer to RN or PT Clinical Utilization reviewer for...(Inpatient, outpatient, or skilled nursing levels of care). + Utilization Management experience preferred + Active licensure… more
- Erickson Living (Peabody, MA)
- …clinical leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management /Safety ... and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice....care, assisted living or hospital) is required.** + Current Registered Nurse license for the state in… more
- Guardian Life (Boston, MA)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Beth Israel Lahey Health (Beverly, MA)
- …care givers, and families. Their functions include concurrent and retrospective review to assure appropriate utilization , assessment, prevention of denials ... school of nursing 2. BSN preferred **Certification/License:** 1. Current Massachusetts RN licensure 2. Certification in Case Management preferred **Patient… more
- Sedgwick (Boston, MA)
- …to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Medicare Compliance **We are growing and looking for nurses who have their ... clinical data; to complete complex submissions revisions/updates in preparation for Medicare review and act as an internal resource regarding Centers for Medicare &… more
- Erickson Living (Hingham, MA)
- …of medical practice; insurance benefit structures and related legal/medical issues; and utilization review and quality assurance procedures. Please note that ... + Researches and selects care options as appropriate. The nurse care coordinator may utilize a range of alternative,...available. **What you will need** + Active Professional Licensed RN required. CCM certification or working toward. + Minimum… more
- East Boston Neighborhood Health Center (East Boston, MA)
- …range planning and determining staffing needs. + Assists Home Care Manager/Residential Nurse manager to monitor utilization and processes for stocking Nursing ... in policy review and revision. Works with Home Care Director/Residential Nurse Manager to update policies, procedures and workflows as needed to ensure… 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
- Beth Israel Lahey Health (Cambridge, MA)
- …Responsible for the overall operation of care transitions discharge planning and/or utilization management departments through oversight of daily and long-term ... advisors. 4. Ensures regulatory compliance and monitoring of key systems, including review and actions towards key performance management indicators related to… more