- Humana (Boston, MA)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Sharecare (Boston, MA)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...the disease management program intervention guidelines. An RN is supervised by an Operations Manager (OM). All… more
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- …Nurse Total Rewards The Community Living Center (CLC) Minimum Data Set (MDS) Registered Nurse ( RN ) is responsible for providing competent, evidence-based ... Summary The Registered Nurse -CLC Minimum Data Set position...and taking corrective action when notified by the CLC management team, charge nurse , or designee of… more
- US Tech Solutions (Canton, MA)
- …license required. Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that is expected to function independently in her ... of clinical decision making and support needed to perform utilization management , medical necessity determinations and benefit...to perform the job Bachelor's degree in Nursing, preferred Registered Nurse with current a and unrestricted… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …medical necessity criteria and BCBSMA policies and procedures + Focus on efficient utilization management with emphasis on discharge planning + Understand and ... to obtain and/or share information relating to benefits and the BCBSMA utilization management process + Collaborate with members/families, providers, medical… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Conduct pre-certification, concurrent, and retrospective reviews with emphasis on utilization management , discharge planning, care coordination, clinical ... Mobile, and Resident personas. This position can be fully remote , with a 1x/month staff meeting in our Hingham,...settings (Inpatient, outpatient, or differing levels of care). + Utilization Management experience, preferred + Experience with… more
- Highmark Health (Boston, MA)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- Atrius Health (Boston, MA)
- …Clinical Director, Nurse Leader or designee, the professional licensed registered nurse provides patient centric, after-hours phone and/or telehealth support ... records system required. *REQUIRED HOURS:* * * *Full time remote Pedi RN 3pm-11:30pm AND 3.0 FTE...Avaya phone system, Outlook, QGenda scheduling, and pdf documentation management . . Remote workers must adhere to… more
- Guardian Life (Boston, MA)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...plan and length of disability. Plan for ongoing case management through proactive partnering with treating providers to move… more
- Highmark Health (Boston, MA)
- … - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care ... Experience in a clinical setting **Preferred** + Certification in utilization management or a related field +...and Family Therapist (LMFT) + Licensed Behavior Specialist + Registered Nurse . **Preferred** + None **SKILLS** +… more
- Children's Hospital Boston (Boston, MA)
- …Planning and or Utilization Management ) preferred. Office/Site Location:BostonRegular, Temporary, Per Diem:Per Diem Remote Eligibility :Onsite Only ... 74825BRJob Posting Title: RN Case Manager, Inpatient & Ambulatory (Per Diem)Department:Patient...length of stay, resource allocation, funding sources, and capacity management to optimize delivery of appropriate services. + Actively… more
- Erickson Living (Hingham, MA)
- …patient-specific outcomes. + Researches and selects care options as appropriate. The nurse care coordinator may utilize a range of alternative, non-medical services ... based on experience* **Schedule** : M-F 830A-5PM on site. Remote not available. **What you will need** + Active...available. **What you will need** + Active Professional Licensed RN required. CCM certification or working toward. + Minimum… more
- Beth Israel Lahey Health (Wakefield, MA)
- …Facility experience preferred. + Active, unrestricted Massachusetts Registered Nurse License required. Certification in Case Management (CCM) preferred. ... making a difference in people's lives.** The Care Manager, RN provides care management services to the...behavior. Working with the healthcare team, the Care Manager, RN monitors appropriate utilization of healthcare resources,… more
- Point32Health (Canton, MA)
- …with the interdisciplinary care team, to improve member outcomes (ie, Utilization Management , Medical Director, pharmacy, community health workers, dementia ... trends in the communities we serve. **Education, Certification and Licensure** + Registered Nurse with current unrestricted license in state of residence… more
- Elevance Health (Woburn, MA)
- …Health location. The ** Nurse Case Manager ll** is responsible for care management within the scope of licensure for members with complex and chronic care needs ... providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** Requires BA/BS… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be ... based on financial ability and forecasting for small to large Operations Management + Collaborate system and data configuration into CES (Claims Editing System)… more