- VitalCore Health Strategies (Hopkinton, MA)
- …Animal/Pet Insurance Employee Assistance Program and Discount Center 401K EEO Keywords: Utilization Management , RN , Nurse , Administrative, #INDMA ... in Correctional Healthcare, has a Full-Time opening for a Utilization Management RN at the...of an accredited School of Nursing Licensure as a Registered Nurse in the state of employment… 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 Zone. + Must have an active and unrestricted RN ( _Registered Nurse_ ) licensure in the state...Previous experience with prior authorization. + Previous experience with utilization management . + Previous experience in an… more
- Humana (Providence, RI)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The RoleThe RN Utilization Management Reviewer is responsible for facilitating care for ... benefit to provide the best quality care. The TeamThe RN Utilization Management Reviewer is...+ Licensure in additional states a plus. + For registered nurses only: a bachelor's degree in (BSN) preferred.… more
- Cognizant (Providence, RI)
- …have to be considered** + Educational background - Registered Nurse ( RN ) + 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- CenterWell (Providence, RI)
- … RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous… more
- Beth Israel Lahey Health (Plymouth, MA)
- …Management Certification required + Minimum of 3 years of progressive experience in utilization management and appeal/denial management . + Holds a strong ... a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... program that enhances the quality of patient care while optimizing resource utilization . Provides training to staff on case management methods and techniques.… more
- CVS Health (Woonsocket, RI)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital… more
- CVS Health (Boston, MA)
- …performance. **Education** Bachelor's degree preferred/specialized training/relevant professional qualification. Registered Nurse ( RN ) required. **Prior ... we do it all with heart, each and every day. Drives effective utilization management practices by ensuring appropriate and cost-effective allocation of… more
- Beth Israel Lahey Health (Cambridge, MA)
- …SKILLS, AND ABILITIES REQUIRED** 1. RN with experience in risk management , quality assessment, or utilization management . 2. Strong spreadsheet, ... Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported...on the key performance indicators and quality measures, the RN specialist also aims to foster a culture of… more
- Brockton Hospital (Brockton, MA)
- Registered Nurse ( RN ), Part- Time Flex Nights, A2-Telemetry Signature Healthcare's Brockton Hospital is hiring for a Part Time Flex Registered Nurse ... available during off-shifts to enhance patient care, staffing, and throughput coordination. Registered Nurse ( RN ) Roles and Responsibilities: + Assessment:… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …true colors to blue. The Role:The Compliance Program Consultant will focus on utilization management compliance and audit readiness activities such as evaluating ... Medical Management 's (HMM) and delegate's compliance with the applicable NCQA utilization management standards and state and federal regulations. The Team:… more
- Brockton Hospital (Brockton, MA)
- Registered Nurse ( RN ), Part-Time, Flex, Nights, 8 Hour Shift, Telemetry Signature Healthcare's Brockton Hospital is hiring for a Part-Time, Flex, 8 Hour ... Shift, Registered Nurse ( RN ) for Telemetry...nursing, the hospitalist team, social work, physical therapy, case management to plan for patient discharge. The majority of… more
- Massachusetts Institute of Technology (Cambridge, MA)
- Registered Nurse , Care Coordinator + Job Number: 25320 + Functional Area: Health Care + Department: MIT Health + School Area: Executive Vice President + Pay ... + Schedule: + Pay Grade: 9 Email a Friend Save Save Apply Now Posting Description REGISTERED NURSE , CARE COORDINATOR, MIT Health, will serve as a core member of… more
- Fresenius Medical Center (Fairhaven, MA)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …concerns Key Qualifications + Strong clinical skills and understanding of HMM's Utilization Management , Case Management and operational procedures, Medical ... concerns that may require additional attention. + Partner with Utilization and Care Management to provide clinical...all levels of the organization. Education and Experience: + Registered nurse with BSN and 3-5 years… more
- Fenway Health (Boston, MA)
- …MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing Job Type Full-time Description As a Registered Nurse ( RN ) at Fenway Health ... to the care team with primary responsibilities for disease management , care coordination, and advice/triage needs for the care...+ Education: Associate degree in nursing + Current Massachusetts Registered Nurse ( RN ) license degree… more
- Beth Israel Lahey Health (Needham, MA)
- …practice model. **Job Description:** **Essential Responsibilities:** 1. Performs utilization management , care coordination, and discharge planning ... 40 hr (every third weekend & rotating holiday required) Job Summary: The RN Case Manager (CM) facilitates the coordination of care for those patients admitted… 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 ... job, you're making a difference in people's lives.** The RN Case Manager working in the Triad Model of...of efficient, high-quality care. This position ensures the appropriate utilization of clinical resources with a goal of a… more
