- 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 CCA ... procedures, and facilities under the provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely… more
- Humana (Boston, MA)
- …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) employment… more
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- …and referred as vacancies become available. This OCA may be used to fill a Registered Nurse (RN) position that is located in the one of following services ... and specialties: CLC-2C CLC-62C CLC-62D CLC-78C The Community Living Center (CLC) Registered Nurse (RN) is responsible for providing competent, evidence-based… more
- Beth Israel Lahey Health (Cambridge, MA)
- …just taking 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
- Point32Health (Canton, MA)
- …job** **Education, Certification and Licensure** + Master's degree preferred. + RN ( Registered Nurse ) with unrestricted MA license preferred. + Certification in ... competence in directing operational compliance with CMS regulatory and NCQA, URAC ( Utilization Review Accreditation Commission) or DOI (Division of Insurance)… 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 ... engagement in self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and provides ongoing… more
- Commonwealth Care Alliance (Boston, MA)
- …member needs are consistently met + Manage panel-wide and member-specific utilization trends. + Liaise with CCA and community-based PCPs/specialists + Collaborate ... planning. + MA / MI only: Reviews approved authorizations to assess appropriate utilization , based on members' needs + Actively participate in the evaluation of own… 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)
- …for this program is provided by the Manager, Patient Programs. **Responsibilities** + Registered Nurse (RN). + 5 years of post-degree clinical experience. + ... Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing criteria. + At minimum must have current and… 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 ... primary responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It… more
- Highmark Health (Boston, MA)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Tufts Medicine (Burlington, MA)
- …**Job Description** **Minimum Qualifications:** 1. Bachelor's Degree in Nursing 2. Active Registered Nurse (RN) license in Massachusetts or compact state 3. ... (ICU, ED, Critical Care, strong Med/Surg Specialty) or equivalent case management, utilization review , denials management, or progressive leadership in an… more
- WTW (Boston, MA)
- …Third Party Administrator, Regulatory Agency, Legal/Compliance Firm, or insurance company + US Registered Nurse or LCSW with active licensed preferred + Health ... issues or impact to timeline proactively to Project Manager + Complete initial review of carrier responses for parity projects + Map carrier responses to appropriate… more
- Tufts Medicine (Boston, MA)
- …of physicians, mid-level practitioners, and may work under the direction of registered nurses depending on their unit. A clinical technologist role that has ... providers who are absent, etc.) by making continual adjustments in room utilization and assignment. 2. Prepares medical record for patient visit, confirming accuracy… more
- Tufts Medicine (Boston, MA)
- …of physicians, mid-level practitioners, and may work under the direction of registered nurses depending on their unit. A clinical technologist role that has ... providers who are absent, etc.) by making continual adjustments in room utilization and assignment. 2. Prepares medical record for patient visit, confirming accuracy… more