- 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
- 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 ... Clinic inpatient admissions. Leads the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case… more
- Beth Israel Lahey Health (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... and educate to improve outcomes. 8. Assists with preparation and presentation of utilization review monitoring/trending reports for review with physicians… more
- Children's Hospital Boston (Boston, MA)
- …Hours per Week:40 Job Posting Category:NursingJob Posting Description:The Utilization Review Nurse will be ... with established procedures, guidelines and criteria + Focusing on high priority utilization review activity including: conducting emergency admission level of… more
- Tufts Medicine (Lowell, MA)
- …with EVD, IABP and Impella patients. The Clinical Leader of ICU-G is a Registered Nurse with responsibility and accountability for the coordination of clinical ... expectations, continuing education, credentialing, performance appraisals, auditing, concurrent monitoring, utilization review , risk management and active problem… more
- Covenant Health (Nashua, NH)
- …attended /documented. + Annual goals are achieved. + Attends pertinent case management/ utilization review programs to maintain current knowledge of UR practices. ... Summary RN Case Managers provide a systematic collaborative approach...or new information to the team. Job Requirements + Registered Nurse licensed in New Hampshire required… more
- Erickson Living (Peabody, MA)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... (skilled nursing, long term care, assisted living or hospital) is required.** + Current Registered Nurse license for the state in which they operate. + Current… more
- Tufts Medicine (Lowell, MA)
- …in clinical practice and customer satisfaction, while striving for optimal efficiency, productivity and utilization of all RN staff to meet the needs of the ... This is great opportunity for an experienced Emergency Services RN that is ready to take the first step...this role you will work closely with the Clinical Nurse Manager in supporting the shared vision for the… more
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- …program office after complete review of the EDRP application. Responsibilities The Registered Nurse position is located in Nursing, Mental Health at the ... total rewards package: VA Nurse Total Rewards The Inpatient Mental Health (MH) Registered Nurse ( RN ) provides and leads the provision of competent,… 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 $10,000 **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
- Tufts Medicine (Lowell, MA)
- …etc.) **Job Description** **Minimum Qualifications:** 1. Bachelor's degree in Nursing (BSN). 2. Registered Nurse ( RN ) license. 3. Basic Life Support (BLS) ... **_Tufts Medicine has a new Community RN Career Pathway plan_** that allows you to...customer satisfaction, while striving for optimal efficiency, productivity, and utilization of all resources. Provides patient and staff 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
- Evolent (Boston, MA)
- …+ Performs other duties as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of ... direct clinical patient care + **Minimum one year of experience with Utilization Review (UM) in a managed care environment** + Cardiology and Oncology Healthcare… more
- Highmark Health (Boston, MA)
- …+ Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN ... Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health… more
- Commonwealth Care Alliance (Boston, MA)
- …claims adjudication, clinical coding reviews for claims, settlement, claims auditing and/or utilization review required + 7+ years experience with Optum Claims ... regulations. The role will also be responsible for timely review and research, as necessary on all new and...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- Highmark Health (Boston, MA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
- Humana (Boston, MA)
- …**Required Qualifications:** **Must meet** **one** **of the following:** + Active unrestricted registered nurse license in the state of Virginia or reside ... case manager required. **Additional Information:** **Workstyle:** Remote work at Home **Location for Registered Nurse :** must reside in the state of Virginia or… more
- Tufts Medicine (Burlington, MA)
- …3. Obtain appropriate state board where services will be provided as a registered professional nurse **OR** Current multi-state licensure through the enhanced ... and smooth flow of communication and administrative support activities for the Utilization and Case Management departments. This position is well versed in insurance… 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 ... you're making a difference in people's lives.** Case Manager RN **Job Description:** **Case Manager RN ** **Position...Case Manager RN **Job Description:** **Case Manager RN ** **Position Summary:** Case managers serve as the care… more