- 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
- 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 ... Weekend and holiday rotations required **Job Description:** The Inpatient Registered Nurse ( RN ) Case Manager...Leads the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review… 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. -Assists with preparation and presentation of utilization review monitoring/trending reports for review with physicians… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare… more
- Cambridge Health Alliance (Cambridge, MA)
- …Center **Work Days:** Generally Mon-Fri days 8-4:30 and one evening/wk **Category:** Registered Nurse **Department:** Office Based Opioid Grant **Job Type:** ... OBOT RN Case Manager **Date Posted:** 01/16/2025 **Requisition Number:**...a business card. * Integrates the discharge planning/coordination and utilization review functions in the case management… 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
- 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 + ... engagement in self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and provides ongoing… 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
- 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 ... ensure the achievement of quality, clinical and cost-effectiveness, and utilization of evidence-based quality practices. The ICM ensures the...EXPERIENCE, TRAINING 1. Maintains an active license as a Registered Nurse , LCSW, or LICSW in Rhode… 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
- Highmark Health (Boston, MA)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management, and… more
- Brockton Hospital (Brockton, MA)
- …preferred. Must have current license from Commonwealth of Massachusetts to practice as a Registered Nurse . Minimum of five years clinical experience in an acute ... care facility required. Prior experience in case management, utilization review or discharge planning required. more
- Guardian Life (Boston, MA)
- **Position Summary** The RN Clinical Consultant serves as a clinical resource for the investigation and assessment of medical information regarding disability by ... medical reviews and analysis of long-term disability claims. The RN Clinical Consultant identifies restrictions, limitations and duration impacting functional… 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
- Beth Israel Lahey Health (Burlington, MA)
- …to the age of the patient Cares for patients as delegated by the provider, RN or LPN within scope of practice and competence. Contributes information provided by the ... plans since last appointment were followed and results are available for physician review Confirms that lab and other ancillary tests are performed and results… more
- Tufts Medicine (Boston, MA)
- …Support duties: Provides basic care services to patients, but does not have an RN or LPN license. Positions in this nursing support work under the direction of ... physicians, mid-level practitioners, and may work under the direction of registered nurses depending on their unit. A clinical technologist role that has specialized… more
- Commonwealth Care Alliance (Boston, MA)
- …administrative delays; that clients are invested in their constituents' adoption and utilization and share performance targets; and that instED has the widest window ... for the department based on the organization's strategic goals. Responsible to review and improve existing sales incentive plans to ensure alignment with sales… 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 (Burlington, MA)
- …the age of the patient. Cares for patients as delegated by the provider, RN or LPN within scope of practice and competence. Contributes information provided by the ... plans since last appointment were followed and results are available for physician review . + Confirms that lab and other ancillary tests are performed, and results… more
- Beth Israel Lahey Health (Burlington, MA)
- …to the age of the patient Cares for patients as delegated by the provider, RN or LPN within scope of practice and competence. Contributes information provided by the ... plans since last appointment were followed and results are available for physician review + Confirms that lab and other ancillary tests are performed and results… more