- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible ... in the area of service decisions and organizational determinations.The Manager, Utilization Management reports to the Director of Clinical Effectiveness.… more
- CVS Health (Boston, MA)
- …**Required Qualifications** + Reside within the Eastern or Central time zone + Utilization management is a 24/7 operation. Work schedules will include weekends ... + 3+ years of clinical hospital experience as a Registered Nurse in Medical/Surgical, Emergency room, Critical...and Excel **Preferred Qualifications** + Managed Care experience + Utilization review experience + Experience working with… more
- Covenant Health (Nashua, NH)
- …the health care team. + Annual goals are achieved. + Attends pertinent case management / utilization review programs to maintain current knowledge of UR ... Summary Conducts medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that...to work remotely as needed Education and Experience + Registered Nurse licensed in New Hampshire required… more
- Molina Healthcare (Waltham, MA)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... identifying opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational… 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
- Humana (Boston, MA)
- … RN , Compliance Nurse 2, Quality Assurance Auditor reviews utilization management activities and documentation to ensure adherence to policies, ... to prevent and detect fraud, waste, and abuse. The RN , Compliance Nurse 2, Quality Assurance Auditor...License the state where you reside + Experience with Utilization Management and Quality assurance audits +… more
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- …considered 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 ... VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities VA offers a...CLC-2C CLC-62C CLC-62D CLC-78C The Community Living Center (CLC) Registered Nurse ( RN ) is responsible… 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...Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to Medical Assistant Treatment Program (MAT) patients. As… 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 ... (ICU, ED, Critical Care, strong Med/Surg Specialty) or equivalent case management , utilization review , denials management , or progressive leadership… more
- Erickson Living (Peabody, MA)
- …clinical leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management /Safety ... and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice....care, assisted living or hospital) is required. + Current Registered Nurse license for the state in… more
- Beth Israel Lahey Health (Charlestown, MA)
- …acute care hospital level nursing experience (eg, medical-surgical, ICU) or equivalent case management , quality, or utilization review in a hospital setting ... accurate DRG assignment, risk of mortality, and severity of illness; and (b) track review details in 3M software. 2. Conducts follow-up reviews of patients every 2… more
- State of Massachusetts (Boston, MA)
- …is seeking an experienced and dynamic Clinical Supervisor of Ambulatory Care Services, Registered Nurse V.The Clinical Supervisor of Ambulatory Care Services is ... and the community, the Clinical Supervisor ensures the effective utilization of resources to enhance patient care. This role...years of full-time, or equivalent part-time, experience as a registered nurse in a recognized hospital, clinic… more
- Amergis (Lawrence, MA)
- **Ple ase only apply if you are a Registered Nurse ** Location: Malden, MA Duration: 13 weeks Start Date: 2-3 weeks from job offer Hours: 40 hours/week Shift: + ... Day shift Requirements: + 2+ year of Home Health RN experience + Supervisory/ Management experience + Clinical...for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers… 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 ... school of nursing 2. BSN preferred **Certification/License:** 1. Current Massachusetts RN licensure 2. Certification in Case Management preferred **Patient… 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
- Beth Israel Lahey Health (Wakefield, MA)
- …considered in lieu of degree. + Active, unrestricted Massachusetts Registered Nurse License required. Certification in Case Management (CCM) preferred. NH ... 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
- Lincoln Financial Group (Boston, MA)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... **What we're looking for** Education * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where… 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 ... Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr....regulations. The role will also be responsible for timely review and research, as necessary on all new and… more