- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… 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
- Beth Israel Lahey Health (Boston, MA)
- …people's lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...required and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse ( RN ), Massachusetts +… 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
- Edward M. Kennedy Community Health Center, Inc. (Milford, MA)
- …may require evening, weekend and/or holiday shifts on a rotating basis. Job Requirements: + Registered Nurse License in MA + 1-2 years of clinical experience + ... The Clinical Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to chronic disease patients, especially to those who are most at… more
- Highmark Health (Boston, MA)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Beth Israel Lahey Health (Cambridge, MA)
- …annually. c. Maintains BLS, ACLS certification d. Attends Emergency Department RN Competency Review Course annually. e. Attends hospital-based Education ... difference in people's lives.** Join our team as a key Emergency Department nurse in our renovated and expanded department, caring for approximately 34,000 patients… more
- Highmark Health (Boston, MA)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- US Tech Solutions (Canton, MA)
- …but required** **unrestricted MA license** **Overview:** We are seeking an experienced ** Utilization Review Nurse ** to provide clinically appropriate and ... cost-effective utilization management and discharge planning for members across multiple inpatient...participate in special projects as assigned. **Qualifications:** + **Education:** Registered Nurse ( RN ) with a… 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...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… 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)
- …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
- Beth Israel Lahey Health (Cambridge, MA)
- …Minimum Qualifications: 1. Bachelor's degree preferred. 2. Current Massachusetts state license as a Registered Nurse ( RN ). 3. Two years of recent acute ... with Harvard Medical School. The Inpatient Case Manager (CM) performs utilization reviews and coordinates discharge planning for MAH inpatient admissions. Inpatient… more
- Prime Healthcare (Woonsocket, RI)
- …is unable to meet the patient's care needs. The ICM is responsible for the utilization review process as it relates to triage and admission to the Behavioral ... for the quality of emergency triage and appropriate resource management for all patients who present for emergent psychiatric...EXPERIENCE, TRAINING 1. Maintains an active license as a Registered Nurse , LCSW, or LICSW in Rhode… more
- Beth Israel Lahey Health (Woburn, MA)
- …the age of the patient D. Cares for patients as delegated by the provider, RN or LPN within scope of practice and competence. E. Contributes information provided by ... plans since last appointment were followed and results are available for physician review o Confirms that lab and other ancillary tests are performed and results… more
- Beth Israel Lahey Health (Cambridge, MA)
- …Responsible for the overall operation of care transitions discharge planning and/or utilization management departments through oversight of daily and long-term ... advisors. 4. Ensures regulatory compliance and monitoring of key systems, including review and actions towards key performance management indicators related to… 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
- Commonwealth Care Alliance (Boston, MA)
- …market, and evolve with our company's capabilities. + Sales Strategy & Management : Develop and implement sales strategy, consistent sales processes, effective daily ... management systems, and methodology for sizing opportunity to drive...that clients are invested in their constituents' adoption and utilization and share performance targets; and that instED has… more