- 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 (Burlington, MA)
- …a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in ... Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality assurance for Lahey… 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
- Baylor Scott & White Health (Boston, MA)
- …vary based on position type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff. You oversee care coordination across ... Factors** + Demonstrable knowledge in discharge planning, case management, utilization review and different care levels. +...experience + Hold a valid registration as a Registered Nurse As a health care system committed to improving… 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
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- Summary The Registered Nurse -CLC Minimum Data Set position is located in Quality and Patient Safety service at the Bedford campus. This position is full time 40 ... hours per week.. Responsibilities VA offers a comprehensive total rewards package: VA Nurse Total Rewards The Community Living Center (CLC) Minimum Data Set (MDS)… 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. (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
- 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
- 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
- Sharecare (Boston, MA)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for early ... participate in the orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required for all Sharecare… more
- Brockton Hospital (Brockton, MA)
- …delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare ... management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience required.… 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
- Evolent (Boston, MA)
- …a mission with a company behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part of ... focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and procedures… 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
- 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