- Milford Regional Medical Center (Milford, MA)
- …with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization management at MRMC. The UR ... year Nurse Case Management experience Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual criteria 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 ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Point32Health (Canton, MA)
- …leading, and modifying the business processes and operations for all levels of utilization management review (ie, Precertification and Intake Services, ... Point32Health business rules; oversight of all aspects of outpatient services utilization management ; and development, implementation and refinement of effective… more
- Humana (Boston, MA)
- …and ad hoc reports in Access and/or 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)… more
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- …by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities VA offers a comprehensive total rewards ... package: VA Nurse Total Rewards This is an open continuous announcement...education, orientation, competencies and providing quality improvement and outcomes utilization consultation. Demonstrates leadership in delivering and improving holistic… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …business expert for member and provider submitted appeals. Working collaboratively with Physician review unit, Utilization Management , Case Management , ... regulatory timeframes.The TeamAs an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer...clinical care experience. + 2 or more years of Utilization Management experience + Excellent computer skills… more
- Beth Israel Lahey Health (Cambridge, MA)
- …a job, you're making a difference in people's lives.** Registered Nurse - Emergency Department **Job Description:** **Primary Responsibilities** 1. The emergency ... nurse initiates accurate and ongoing assessment of physical, psychological...subjective and objective data through history taking, physical examination, review of records and communication with health care providers,… more
- Cambridge Health Alliance (Cambridge, MA)
- …team leader in multi-disciplinary team discussion regarding treatment planning, treatment review , quality assurance and utilization review ... Nurse Practitioner - Clinical Specialist II (APRN), Psychiatry...to nursing policy and procedure. + Communicate effectively with management , peers, and health team members. + Interact effectively… 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 ... bonus up to $7,500** + **Day 1 Benefits!** The Nurse Manager is responsible for the management ...The Nurse Manager is responsible for the management of the medical/nursing services provided in the detoxification… more
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …Clinical Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to Medical Assistant Treatment Program (MAT) patients. As an employer ... patients receive optimal care including acute illness and chronic disease management , education about lifestyle and behavior modification, and preventive care across… more
- Edward M. Kennedy Community Health Center, Inc. (Milford, MA)
- …The Clinical Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to chronic disease patients, especially to those who are most at ... patients receive optimal care including acute illness and chronic disease management , education about lifestyle and behavior modification, and preventive care across… 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
- Prime Therapeutics (Boston, MA)
- …+ Escalates medical exception requests to nurse , pharmacist or physician on the utilization review clinical team when further review is necessary. + ... company achieving revenue goals and operational objectives. Responsible for executing utilization management programs on behalf of health plan/payor customers,… 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 ... & Responsibilities including but not limited to:** 1) Performs utilization review and discharge planning to inpatient...of medical/surgical nursing care experience. Two years of case management or utilization management experience… 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 ... and/or transfer in collaboration with the physician and primary nurse . Identify high-risk social situations to intervene in and...: Three years of acute care experience **Preferred:** Case Management or Utilization Management experience… 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
- State of Massachusetts (Milford, MA)
- …needed with working knowledge in contract compliance, quality assurance activities, utilization review , problem identification and analysis, staffing patterns, ... quality, comprehensive Medical, Dental and Mental Health Services. Will review the quality of documentation in medical records and...REQUIREMENTS: * The applicant must be a Licensed Registered Nurse , Clinical Nurse Specialist or Nurse… more
- Elevance Health (Woburn, MA)
- …**How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and ... responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment… more
- Tufts Medicine (Burlington, MA)
- …hospital setting (ICU, ED, Critical Care, strong Med/Surg Specialty) or equivalent case management , utilization review , denials management , or ... Qualifications:** 1. Bachelor's Degree in Nursing 2. Active Registered Nurse (RN) license in Massachusetts or compact state 3....other Quality indicators where indicated. 10. Collaborates with case management and utilization review team… more