- Beth Israel Lahey Health (Burlington, MA)
- …a difference in people's lives.** 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
- Beth Israel Lahey Health (Burlington, MA)
- …Weekend Rotation **Job Description:** 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
- Beth Israel Lahey Health (Burlington, MA)
- …in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse ( RN ) Case ... Clinic inpatient admissions. Leads the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case… 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 ... and educate to improve outcomes. 8. Assists with preparation and presentation of utilization review monitoring/trending reports for review with physicians… more
- Children's Hospital Boston (Boston, MA)
- …Hours per Week:40 Job Posting Category:NursingJob Posting Description:The Utilization Review Nurse will be ... with established procedures, guidelines and criteria + Focusing on high priority utilization review activity including: conducting emergency admission level of… more
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- …program office after complete review of the EDRP application. Responsibilities The Registered Nurse position is located in Nursing, Mental Health at the ... total rewards package: VA Nurse Total Rewards The Inpatient Mental Health (MH) Registered Nurse ( RN ) provides and leads the provision of competent,… more
- Beth Israel Lahey Health (Cambridge, MA)
- …needs throughout the spectrum of life, from pediatrics to older adults. **Job Description:** Registered Nurse - Sign on Bonus eligibility up to $12,000 **Primary ... lives.** Join our team as a key Emergency Department nurse in our renovated and expanded department, caring for...c. Maintains BLS, ACLS certification d. Attends Emergency Department RN Competency Review Course annually. e. Attends… 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...self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and… more
- Evolent (Boston, MA)
- …+ Performs other duties as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of ... direct clinical patient care + **Minimum one year of experience with Utilization Review (UM) in a managed care environment** + Cardiology and Oncology Healthcare… more
- Highmark Health (Boston, MA)
- …+ Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN ... Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health… 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 ... regulations. The role will also be responsible for timely review and research, as necessary on all new and...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- Fallon Health (Worcester, MA)
- …degree in nursing required. **License/Certifications** Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience** + A minimum of ... three to five years clinical experience as a Registered Nurse in a clinical setting required....clinical setting required. + 2 years' experience as a Utilization Management nurse in a managed care… more
- Humana (Boston, MA)
- …**Required Qualifications:** **Must meet** **one** **of the following:** + Active unrestricted registered nurse license in the state of Virginia or reside ... case manager required. **Additional Information:** **Workstyle:** Remote work at Home **Location for Registered Nurse :** must reside in the state of Virginia or… more
- Tufts Medicine (Burlington, MA)
- …3. Obtain appropriate state board where services will be provided as a registered professional nurse **OR** Current multi-state licensure through the enhanced ... and smooth flow of communication and administrative support activities for the Utilization and Case Management departments. This position is well versed in insurance… more
- Sedgwick (Boston, MA)
- …to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Medicare Compliance **We are growing and looking for nurses who have their ... clinical data; to complete complex submissions revisions/updates in preparation for Medicare review and act as an internal resource regarding Centers for Medicare &… 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
- Fallon Health (Worcester, MA)
- …degree in nursing required **License/Certifications:** Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience:** * A minimum of ... Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review ...three to five years clinical experience as a Registered Nurse in a clinical setting required.… more
- Tufts Medicine (Boston, MA)
- …**Job Description** **Minimum Qualifications** **:** 1. Master's degree in Nursing (MSN). 2. Registered Nurse ( RN ) license. 3. Advanced Practice ... **Job Overview** This position is responsible for the direction of Nurse Practitioners, including arrangement of schedules, staffing during vacations, direction of… more
- State of Massachusetts (Wrentham, MA)
- …have at least (A) four years of full-time or equivalent part-time experience as a registered nurse in a recognized hospital, clinic, or medical facility and (B) ... from an approved school of nursing must have applied for the first available registered nurse examination. Based on assignment, possession of a current and valid… more
- Beth Israel Lahey Health (Cambridge, MA)
- …for the overall operation of care transitions discharge planning and/or utilization management departments through oversight of daily and long-term activities at ... **Job Description:** **PLANNING:** Plans department's clinical services and operations including review of tracking and trending data to assess need for performance… more