- Cognizant (Boston, MA)
- …+ Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical … 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 ... necessity of the hospital care. Using the concepts of utilization review, clinical documentation improvement and revenue...in a clear and concise manner to the medical, clinical , and management staff. 12. Applies diplomacy… more
- Evolent (Boston, MA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Fresenius Medical Center (Lowell, MA)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Fenway Health (Boston, MA)
- …patient-centeredness, non-judgmental, harm reduction, behavioral health integration, and team-based care. The nurse serves in a clinical leadership role to the ... Registered Nurse Boston, MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing Job Type...care team with primary responsibilities for disease management , care coordination, and advice/triage needs for the care… more
- CVS Health (Boston, MA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Lawrence General Hospital (Lawrence, MA)
- …appropriate discharge plans. + Works in conjunction with Utilization Review Nurse , Social Worker and Clinical Care Leader to ensure all appropriate ... care setting with discharge planning, continuing care, care management , and utilization review. + Five years clinical nursing experience required +… more
- Atrius Health (Newton, MA)
- …includes a minimum of 3 years in utilization management or case management . . Minimum of 3-5 years clinical experience with home health care experience ... health and welfare benefit package. **Job:** **Nursing* **Organization:** **Case Management * **Title:** *CMRN-Ambulatory Nurse Case Manager (MNA)* **Location:**… more
- Evolent (Boston, MA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Beth Israel Lahey Health (Boston, MA)
- …focusing on the delivery of efficient, high-quality care. This position ensures the appropriate utilization of clinical resources with a goal of a safe and ... quality indicators such as avoidable delays, length of stay, resource utilization , patient satisfaction, patient flow, outlier management , and readmissions… more
- Atrius Health (Watertown, MA)
- …of the Department Chief, Nurse Leader or designee, this registered professional nurse provides practice support to a clinical team, recognizing the patient ... across the lifespan. This position is responsible for effective care delivery and management of patient care within a specialty, utilizing the nursing process and… more
- Beth Israel Lahey Health (Cambridge, MA)
- …with Harvard Medical School. The Inpatient Case Manager (CM) performs utilization reviews and coordinates discharge planning for MAH inpatient admissions. Inpatient ... Case Manager Guidelines and audit tool. Reports to Inpatient Case Management Supervisor. **Job Description:** **Essential Duties & Responsibilities (including but… more
- Tufts Medicine (Lowell, MA)
- …to weekend clinical and administrative staff. + Provides the direct management of the Weekend clinical staff, schedulers, intake supervisor and Weekend ... State and federal home health regulations. Responsible for the management of cost effective, efficient care to home health...regarding pre and post weekend follow-up. + Promotes efficient utilization of resources to achieve desired clinical … more
- Tufts Medicine (Lowell, MA)
- … such as interviewing, hiring, and disciplinary action. + Promotes efficient utilization of resources to achieve desired clinical outcomes and within ... with agency policy, State and federal home health regulations. Responsible for the management of cost effective, efficient care to home health patients ensuring the… more
- Fresenius Medical Center (Medford, MA)
- …staff training, equipment, physician and patient relations, cost containment, supply management , medical records, patient billing, OSHA and all company, state and ... by working with the Vice President of Quality and other organization management to ensure that organization/ASC policies and procedures are followed. + Responsible… more
- Deloitte (Boston, MA)
- … registered nurse , physician, physician assistant, case manager, clinical documentation specialist, utilization review, informatics RN, Quality, DRG ... and informal education of physicians, CDI team, health information management and other clinical staff + Develop...medical degree, or physician assistant required + Current Registered Nurse (RN) license required + Certified Clinical … more
- Edwards Lifesciences (Boston, MA)
- …post-case management , 3 Mensio management , Therapy Awareness program management and clinical education programs. + Implementing sales and educational ... and implementing growth strategies within focused accounts in partnership with Sales Management . + Developing clinical champions among current and potential… more
- Beth Israel Lahey Health (Boston, MA)
- …and Emergency Department. In absence of Admission Facilitator, directs bed utilization . + Provides clinical consultation, support, education and mentoring ... in the evaluation of staff as requested by the nurse manager. + Rounds on the clinical ...and across functional areas. Results have implications for the management and operations of multiple areas of the organization.… more
- Philips (Cambridge, MA)
- …etc) with clinical experience as Radiologic Technologist (RT) or Registered Nurse (RN) highly preferred. + Experience in healthcare (in the hospital) within ... **Sales Support, Clinical Specialist - FORS (West/National Travel)** In this...to effectively manage assigned accounts in terms of driving utilization , customer relationship management , problem resolution, etc.… more
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …team is expanding across sites to support this growth. We are currently hiring a Clinical Care Manager - OBAT RN based in Framingham. As part of a team-based ... approach to care, the Clinical Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to Medical Assistant Treatment Program… more