- 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 CCA… more
- CVS Health (Woonsocket, RI)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- CenterWell (Boston, MA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Fallon Health (Worcester, MA)
- … Nurse in a clinical setting required. * 2 years' experience as a Utilization Management /Prior Authorization nurse in a managed care payer preferred. * ... Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests (prior-authorizations),… more
- Fenway Health (Boston, MA)
- Registered Nurse , Per Diem Boston, MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing Job Type Part-time Description As a Registered ... Nurse (RN) at Fenway Health you will provide compassionate,...to the care team with primary responsibilities for disease management , care coordination, and advice/triage needs for the care… more
- CVS Health (Woonsocket, RI)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Atrius Health (Dedham, MA)
- …value-based care system in the country. *_SUMMARY_*__ Physician Assistant/ Nurse Practitioner (MNA) position supporting our Orthopedics department. The Physician ... Assistant/ Nurse Practitioner will work collaboratively on a team to...urgent care, a range of wellness visits, chronic disease management and acute care. We offer superior staffing resources… more
- Dana-Farber Cancer Institute (Boston, MA)
- The Nurse Director for Care Coordination directs and oversees a team responsible for patient care coordination, including utilization review, intake or discharge ... including other Harvard Medical School-affiliated hospitals. **Leadership and Team Management :** Effective leadership in nursing involves creating a positive work… more
- Evolent (Boston, MA)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Atrius Health (Boston, MA)
- …Growing together.* *SUMMARY * Under the direction of the Department Chief, Nurse Leader or designee, this registered professional nurse provides practice ... 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 (Boston, MA)
- …Growing together. *SUMMARY * Under the direction of the Department Chief, Nurse Leader or designee, this registered professional nurse provides practice ... 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 (Boston, MA)
- …quality indicators such as avoidable delays, length of stay, resource utilization , patient satisfaction, patient flow, outlier management , and readmissions ... of efficient, high-quality care. This position ensures the appropriate utilization of clinical resources with a goal of a...not captured by another Care Transitions Team member), case management assessments, and care plans in a thorough and… more
- Beth Israel Lahey Health (Needham, MA)
- …regulatory equipment are met and/or exceeded. Optimal patient care and cost effective management is maintained through utilization of data and information from ... you're making a difference in people's lives.** Job Summary: The nurse director provides 24-hour operational accountability for his/her unit(s). Collaborates with… more
- ZOLL Medical Corporation (Boston, MA)
- …patients suffering from serious cardiopulmonary and respiratory conditions.ZOLL Cardiac Management Solutions offers a unique portfolio of novel technologies designed ... patients at risk of sudden cardiac death. + HFMS (https://cardiacdiagnostics.zoll.com/products/heart-failure-arrhythmia- management -system/) (Heart Failure Management system) is a… more
- Tufts Medicine (Boston, MA)
- …the excision or incision of a patient's body, such as interventional pain management and other procedures. This position also works to provide a safe environment ... the direction of the surgeon. 6. Performs all counts with the circulating nurse according to Operating Room policy. 7. Manages all intraoperative medications in… more
- Tufts Medicine (Boston, MA)
- …the excision or incision of a patient's body, such as interventional pain management and other procedures. This position also works to provide a safe environment ... the direction of the surgeon. 6. Performs all counts with the circulating nurse according to Operating Room policy. 7. Manages all intraoperative medications in… more
- Sharecare (Boston, MA)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- GE Aerospace (Boston, MA)
- …within manufacturing lines to achieve Operating goals using **KPI-based** performance management . + **Coach and Collaborate** with all levels of the organization ... of Lean principles. + Partner, develop and execute standard **Capacity Utilization ** process in partnership with the local Operations, Lean and Industrial… more
- Highmark Health (Boston, MA)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- Atrius Health (Boston, MA)
- …the department chief, nurse leader or designee, this registered professional nurse position provides practice management support as well as initiating and/or ... direct patient care to patients, according to established guidelines. The Special Procedure nurse performs a variety of complex tasks which may include assisting in… more
