- VitalCore Health Strategies (Hopkinton, MA)
- …Insurance Employee Assistance Program and Discount Center 401K EEO Keywords: Utilization Management , RN, Nurse , Administrative, #INDMA Compensation ... in Correctional Healthcare, has a Full-Time opening for a Utilization Management RN at the Regional Office...an accredited School of Nursing Licensure as a Registered Nurse in the state of employment with 1+ years… more
- CVS Health (Boston, MA)
- …we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** utilizes ... Time_ ). + Previous experience with prior authorization. + Previous experience with utilization management . + Previous experience in an acute care setting. +… more
- CenterWell (Boston, MA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Cognizant (Boston, MA)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- Fallon Health (Worcester, MA)
- … Nurse in a clinical setting required. * 2 years' experience as a Utilization Management /Prior Authorization nurse in a managed care payer preferred. * ... Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests (prior-authorizations),… more
- Beth Israel Lahey Health (Burlington, MA)
- …weekends. This position is on-site at Lahey Hospital and Medical Center. The Utilization Analyst works with physicians, the payers and inpatient case management ... medical necessity of the hospital care. Using the concepts of utilization review, clinical documentation improvement and revenue integrity, these specialized case… more
- Fenway Health (Boston, MA)
- Registered Nurse , Per Diem Boston, MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing Job Type Part-time Description As a Registered ... Nurse (RN) at Fenway Health you will provide compassionate,...to the care team with primary responsibilities for disease management , care coordination, and advice/triage needs for the care… more
- CVS Health (Boston, MA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Lawrence General Hospital (Lawrence, MA)
- …referrals and facilitates appropriate discharge plans. + Works in conjunction with Utilization Review Nurse , Social Worker and Clinical Care Leader to ... experience in an acute care setting with discharge planning, continuing care, care management , and utilization review. + Five years clinical nursing experience… 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 ... to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by leading the… more
- Dana-Farber Cancer Institute (Boston, MA)
- The Nurse Director for Care Coordination directs and oversees a team responsible for patient care coordination, including utilization review, intake or discharge ... including other Harvard Medical School-affiliated hospitals. **Leadership and Team Management :** Effective leadership in nursing involves creating a positive work… more
- Evolent (Boston, MA)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Atrius Health (Chelmsford, MA)
- …Growing together.* *SUMMARY * Under the direction of the Department Chief, Nurse Leader or designee, this registered professional nurse provides practice ... 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
- Massachusetts Institute of Technology (Cambridge, MA)
- …patients, families, providers, and community agencies. PREFERRED: two years of case management , utilization review, and discharge planning experience. 11/18/2025 ... Registered Nurse , Care Coordinator + Job Number: 25320 +...a Friend Save Save Apply Now Posting Description REGISTERED NURSE , CARE COORDINATOR, MIT Health, will serve as a… more
- Evolent (Boston, MA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Atrius Health (Newton, MA)
- …. Minimum 5 years nursing experience, which includes a minimum of 3 years in utilization management or case management . . Minimum of 3-5 years clinical ... health and welfare benefit package. **Job:** **Nursing* **Organization:** **Case Management * **Title:** *CMRN-Ambulatory Nurse Case Manager (MNA)* **Location:**… 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
- Beth Israel Lahey Health (Boston, MA)
- …quality indicators such as avoidable delays, length of stay, resource utilization , patient satisfaction, patient flow, outlier management , and readmissions ... of efficient, high-quality care. This position ensures the appropriate utilization of clinical resources with a goal of a...not captured by another Care Transitions Team member), case management assessments, and care plans in a thorough and… more
- Lawrence General Hospital (Methuen, MA)
- …experience in an acute care setting with discharge planning, continuing care, care management , and utilization review preferred. ? Strong verbal and written ... assigned to selected areas of the Hospital on a rotating basis to perform utilization reviews and other UM activities, as needed, to be based upon department… more
- Beth Israel Lahey Health (Wakefield, MA)
- …population health and is responsible to ensure that quality and efficient care management services are provided to the BILHPN provider's risk populations. The Care ... Manager provides care management services to the BILHPN primary care physicians focusing...focusing care coordination attention on the at-risk population driving utilization and costs to improve efficiency, quality and patient… more
