- CVS Health (Woonsocket, RI)
- …And we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- Humana (Providence, RI)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CenterWell (Providence, RI)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Evolent (Providence, RI)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Dana-Farber Cancer Institute (Attleboro, MA)
- …Director of Nursing is responsible for the planning, implementation and evaluation of clinical operations and personnel management of the assigned patient care ... the highest quality patient experience while maximizing provider time and space utilization . The Nurse Director uses extensive theoretical, evidence-based, and… more
- Atrius Health (Easton, 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
- Edwards Lifesciences (Providence, RI)
- …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
- Edward M. Kennedy Community Health Center, Inc. (Milford, MA)
- …Requirements: + Registered Nurse License in MA + 1-2 years of clinical experience + Current CPR certification. Benefits: + Competitive salary based on related ... to support this growth. We are currently hiring a Clinical Care Manager based in Milford, MA. The ...Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to chronic disease patients, especially to those who… more
- Charter Care Health Partners (North Providence, RI)
- …Continuum of Care Management (Discharge planning) and Clinical Documentation Management . Collects data via utilization with Care Port to enhance the ... residency if that state is a member of the Nurse Licensure Compact. Five (5) years of clinical...clinical experience that includes recent experience with case management , patient navigation, case management , utilization… more
- Charter Care Health Partners (North Providence, RI)
- …Continuum of Care Management (Discharge planning) and Clinical Documentation Management . Collects data via utilization with Care Port to enhance the ... residency if that state is a member of the Nurse Licensure Compact. Five (5) years of clinical...clinical experience that includes recent experience with case management , patient navigation, case management , utilization… more
- Datavant (Providence, RI)
- …function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal ... The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity and… more
- Sharecare (Providence, RI)
- …3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case ... / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical,… more
- Oracle (Providence, RI)
- …of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will ... These include, but are not limited to, multiple Essential Clinical Dataset (ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding,… more
- State of Massachusetts (Canton, MA)
- …or rehabilitation experience. . Proven expertise in quality improvement, performance management , and ensuring compliance with regulatory and clinical standards. ... nursing and respiratory therapy services while shaping the strategic direction of clinical operations in collaboration with senior leadership. With a strong focus on… more
- Highmark Health (Providence, RI)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...- 5 years of related, progressive experience in a clinical setting **Preferred** + 1-3 years of experience in… more