- US Tech Solutions (Canton, MA)
- …but required** **unrestricted MA license** **Overview:** We are seeking an experienced ** Utilization Review Nurse ** to provide clinically appropriate and ... effectively through their continuum of care. **Key Responsibilities:** + Perform utilization management activities, applying criteria such as InterQual, MCG, and… more
- Beth Israel Lahey Health (Boston, MA)
- …lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse (RN), Massachusetts + Three years of recent clinical… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Beth Israel Lahey Health (Cambridge, MA)
- …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 ... to older adults. **Job Description:** **Primary Responsibilities** 1. The emergency nurse initiates accurate and ongoing assessment of physical, psychological and… more
- Beth Israel Lahey Health (Wakefield, MA)
- …Working with the healthcare team, the Care Manager, RN monitors appropriate utilization of healthcare resources, promotes quality and efficiency by developing and ... management by focusing care coordination attention on the at-risk population driving utilization and costs to improve efficiency, quality and patient satisfaction. -… more
- Cambridge Health Alliance (Cambridge, MA)
- …team leader in multi-disciplinary team discussion regarding treatment planning, treatment review , quality assurance and utilization review ... Nurse Practitioner - Clinical Specialist II (APRN), Psychiatry...authorizing practice in an expanded role as a Psychiatric Nurse Clinical Specialist and authorization including prescriptive authority. _In… 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 ... (including but not limited to): 1. Using established clinical criteria, the Nurse Case Manager identifies and communicates to the team opportunities for providing… more
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …engagement in self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and provides ongoing ... point-of-care testing, treatments, and lab and diagnostic test result review + Provides timely and informed patient triage +...shifts on a rotating basis. Required Qualifications: + Registered Nurse License in MA + Bachelor's degree in Nursing… more
- Edward M. Kennedy Community Health Center, Inc. (Milford, MA)
- …engagement in self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and provides ongoing ... point-of-care testing, treatments, and lab and diagnostic test result review + Documents patient care, ongoing evaluation, patient progress/risk status,… 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
- Evolent (Boston, MA)
- …be the single point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work can be divided into ... for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for utilization … 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
- Highmark Health (Boston, MA)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to assure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management, and… 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 ... facilitate ensure the achievement of quality, clinical and cost-effectiveness, and utilization of evidence-based quality practices. The ICM ensures the comprehensive… more
- United Therapeutics (Boston, MA)
- …reimbursement support, patient support programs, field reimbursement managers, patient navigators and nurse educators + Review Needs Assessment Forms related to ... with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was… more
- Fallon Health (Worcester, MA)
- …in internal clinical rounds and huddles o Works with members of the Utilization Management Department assisting with difficult or complex care delivery or discharge ... Beacon team and collaborate on high-risk members to decrease utilization o May collaborate with staff on site to...to engage in Interdisciplinary team meetings o Works with Nurse Case Managers and Navigators to coordinate a continuum… more
- GE Vernova (Foxborough, MA)
- …+ Hold operating rhythm, pacing calls on Resource/workload management, Engineering utilization , Budget Deviation, On Time Delivery (OTD), Say Do Ratio (SDR), ... Customer comments. + Collaborate with Project Controls to have monthly rhythm to review workload vs capacity and work with department managers on their respective… more
- Tufts Medicine (Boston, MA)
- …providers who are absent, etc.) by making continual adjustments in room utilization and assignment. 2. Prepares medical record for patient visit, confirming accuracy ... arranging for diagnostic testing, surgery and in-patient admissions under direction of the nurse or physician. 14. Assists with patient billing by ensuring CPT code,… more
- Dana-Farber Cancer Institute (Boston, MA)
- …practitioner group consisting of physicians, physician's assistants, program nurses and nurse practitioners and other care providers, the individuals in this ... the assigned patient population to achieve patient safety, flow and resource utilization goals of the organization and sponsoring agencies; + Responsible for… more
- The Home for Little Wanderers (Dorchester, MA)
- …documentation and billing in a timely manner. Ensure that documentation meets utilization review and quality assurance standards. + Attend in-service training ... Therapy, Family Partners, Young Adult Peer Mentor, Vocational Specialists, and Psychiatrists/ Nurse Prescribers to help support growth and recovery for youth and… more