- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring… more
- CenterWell (Boston, MA)
- …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
- 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)
- … Reviewer, Nurse , you will routinely interact with leadership and management staff, other CR's ( Clinical Reviewers), providers, office staff and Field ... culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse , you will be a..., you will be a key member of the utilization management team. We can offer you… 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
- Beth Israel Lahey Health (Boston, MA)
- …Demonstrates professional commitment and is responsible for ensuring patient safety. **Resource Utilization ** + The registered nurse considers factors related to ... job, you're making a difference in people's lives.** Operating Room (OR) Registered Nurse - New England Baptist Hospital Full Time Operating room Registered Nurse… 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
- Beth Israel Lahey Health (Cambridge, MA)
- …completed). **KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED** 1. RN with experience in risk management , quality assessment, or utilization management . 2. Strong ... reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review...clinical abstracts, identifies quality of care and risk management issues. Uses clinical knowledge to assess… more
- Atrius Health (Dedham, MA)
- … Professional* **Organization:** **Orthopedics* **Title:** *Specialty Physician Assistant/ Nurse Practitioner (MNA) - Orthopedics (OR)* **Location:** *Dedham MA ... value-based care system in the country. *_SUMMARY_*__ Physician Assistant/ Nurse Practitioner (MNA) position supporting our Orthopedics department. The Physician… more
- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work ... Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG… more
- Atrius Health (Boston, MA)
- …providers to ensure efficient and outstanding quality of care. This registered professional nurse provides practice support to a clinical team, recognizing the ... the direction of the Department Chief Physician and Nursing Supervisor, this Registered Nurse position is responsible for effective care delivery and management … 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 (Dedham, 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
- 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
- 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
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …Job Requirements: + Registered Nurse License in MA + 1-2 years of clinical experience + Current CPR certification + Our health center requires all employees to ... to support this growth. We are currently hiring a Clinical Care Manager based in Framingham, MA. The ...Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to chronic disease patients, especially to those who… 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