- Southern New Hampshire Health (Chelmsford, MA)
- CLINICAL TEACHER / NURSE EDUCATOR - EMERGENCY DEPARTMENT Who We Are: The Emergency Department of SNHMC provides culturally competent care to the diverse population ... and higher acuity, the ED is prepared to accommodate additional patients through utilization of hallway beds and a triage fast-track area. We support and take… more
- Lawrence General Hospital (Lawrence, MA)
- The Utilization Review Nurse is responsible for determining the appropriateness of hospital admission, utilization of resources and medical necessity for ... compliance with the conditions of participation as they relate to Utilization Review and Discharge planning and payer regulations. Graduate of an accredited… more
- Beth Israel Lahey Health (Burlington, MA)
- …difference in people's lives.** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse (RN), Massachusetts + Three years of recent clinical… more
- Beth Israel Lahey Health (Burlington, MA)
- …Rotation **Job Description:** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse (RN), Massachusetts + Three years of recent clinical… more
- Beth Israel Lahey Health (Burlington, MA)
- …you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered ... Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality assurance for Lahey… 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
- Humana (Boston, MA)
- …problem-solving skills, facilitation skills **Preferred Qualifications** + Experience with utilization review process + Experience with behavioral change, ... caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health...meet one of the following:** + Active unrestricted registered nurse license in the state of Virginia or obtain… more
- Humana (Boston, MA)
- …our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to support ... of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines and… more
- Tufts Medicine (Burlington, MA)
- …and smooth flow of communication and administrative support activities for the Utilization and Case Management departments. This position is well versed in insurance ... state board where services will be provided as a registered professional nurse **OR** Current multi-state licensure through the enhanced Nurse Licensure… more
- Beth Israel Lahey Health (Cambridge, MA)
- …difference in people's lives.** Join our team as a key Emergency Department nurse in our renovated and expanded department, caring for approximately 34,000 patients ... spectrum of life, from pediatrics to older adults. **Job Description:** Registered Nurse - Sign on Bonus eligibility up to $12,000 **Primary Responsibilities** 1.… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following ... services or forward requests to the appropriate stakeholder. The Pre-Authorization Nurse 2 work assignments are varied and frequently require interpretation and… more
- Tufts Medicine (Lowell, MA)
- …continuing education, credentialing, performance appraisals, auditing, concurrent monitoring, utilization review , risk management and active problem ... IABP and Impella patients. The Clinical Leader of ICU-G is a Registered Nurse with responsibility and accountability for the coordination of clinical activities and… 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...authorizing practice in an expanded role as a Psychiatric Nurse Clinical Specialist and authorization including prescriptive authority. _In… more
- Tufts Medicine (Lowell, MA)
- …care for the department. In this role you will work closely with the Clinical Nurse Manager in supporting the shared vision for the unit. You will develop and ... clinical practice and customer satisfaction, while striving for optimal efficiency, productivity and utilization of all RN staff to meet the needs of the diverse… more
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …engagement in self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and provides ongoing ... point-of-care testing, treatments, and lab and diagnostic test result review + Provides timely and informed patient triage +...shifts on a rotating basis. Required Qualifications: + Registered Nurse License in MA + Bachelor's degree in Nursing… more
- Tufts Medicine (Lowell, MA)
- …and customer satisfaction, while striving for optimal efficiency, productivity, and utilization of all resources. Provides patient and staff education, clinical ... participates in unit-based activities (quality assessment, shared governance, quality review , staff development in-services, simulation drills, etc.) **Job Description**… more
- Brockton Hospital (Brockton, MA)
- …delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare ... management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience required.… more
- Evolent (Boston, MA)
- …be the single point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work can be divided into ... for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for utilization … 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
- Highmark Health (Boston, MA)
- …Health **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
