- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring ... facilities under the provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer ...**What You'll Be Doing:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring ... facilities under the provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer ...**What You'll Be Doing:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Lincoln Financial Group (Boston, MA)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… 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
- 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
- Humana (Boston, MA)
- …excellent written and verbal communication **Preferred Qualifications** + Registered Nurse + Experience in Medicare Utilization Management + Project ... are addressed. They will work closely with established functions inside utilization management (Medical Director, clinician decision making teams, quality audits,… more
- Point32Health (Canton, MA)
- …perform the job** **Education, Certification and Licensure** + Master's degree preferred. + RN ( Registered Nurse ) with unrestricted MA license preferred. + ... competence in directing operational compliance with CMS regulatory and NCQA, URAC ( Utilization Review Accreditation Commission) or DOI (Division of Insurance)… 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
- Elevance Health (Woburn, MA)
- **Anticipated End Date:** 2024-09-16 **Position Title:** RN Hospital Bill Audit/Appeal Lead **Job Description:** ** RN Hospital Bill Audit/Appeal Lead** ... is determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** RN Hospital Audit/Appeal Lead** is responsible for leading a team of… more
- Elevance Health (Woburn, MA)
- …Knowledge of health insurance/benefits, medical management process, care management, and utilization review management strongly preferred. For candidates working ... **Anticipated End Date:** 2024-09-13 **Position Title:** Telephonic Nurse Case Manager II **Job Description:** **Telephonic Nurse Case Manager II** **Location:… more
- Elevance Health (Woburn, MA)
- **Anticipated End Date:** 2024-09-11 **Position Title:** Nurse Case Manager II **Job Description:** **Telephonic Nurse Case Manager II** **Location: This is a ... PulsePoint location.** **Hours: Monday - Friday 8:30am to 5:00pm EST** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope… more
- Beth Israel Lahey Health (Danvers, MA)
- …application of Quality Assurance and Customer Service Programs, implementation of Utilization Review mechanisms; structuring clinical supervision; provision of ... $7500 (prorated for part-time)** + **Day 1 Benefits!** The Nurse Manager is responsible for the management of the...daily operations of the program by providing supervision to RN 's and LPN's. This is a great opportunity to… more
- Humana (Boston, MA)
- …SQL + Graduate degree + Utilization Management Review Experience + Registered Nurse ( RN ) Credentials + Home Health, Durable Medical Equipment, and/or ... Skilled Nursing Facility Experience **Additional Information** **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The… more
- Bear Mountain Health Care (Lowell, MA)
- …+ Meetings: Attending various meetings, including Morning Clinical Meeting, Utilization Review , At-Risk/Behavior Meeting, and QAPI (Quality Assurance ... maintaining high-quality care standards. Compensation: + LPN $40-$46/hr based on experience + RN $44-$52/hr based on experience How to Apply: If you are interested… 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)
- …Third Party Administrator, Regulatory Agency, Legal/Compliance Firm, or insurance company + US Registered Nurse or LCSW with active licensed preferred + Health ... issues or impact to timeline proactively to Project Manager + Complete initial review of carrier responses for parity projects + Map carrier responses to appropriate… 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...status patients by working with physicians to ensure appropriate utilization . 8. Is part of the department's Saturday, holiday… 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 in an… more