- 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
- 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. +...work experience + Hold a valid registration as a Registered Nurse As a health care system… more
- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse 2...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… 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
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- …Nurse Total Rewards The Community Living Center (CLC) Minimum Data Set (MDS) Registered Nurse ( RN ) is responsible for providing competent, evidence-based ... Summary The Registered Nurse -CLC Minimum Data Set position...education, orientation, competencies and providing quality improvement and outcomes utilization consultation. Demonstrates leadership in delivering and improving holistic… 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
- Sharecare (Boston, MA)
- …support appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... Hours are on Central Standard Time. **Job Summary:** The RN has the responsibility for supporting the goals and...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… 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
- 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
- Highmark Health (Boston, MA)
- …+ Licensed Marriage and Family Therapist (LMFT) + Licensed Behavior Specialist + Registered Nurse . **Preferred** + None **SKILLS** + Working knowledge of ... Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care… 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
- Evolent (Boston, MA)
- …are applied appropriately. **Qualifications:** + Current, unrestricted state licensure as a Registered Nurse + Associate or Bachelors in Nursing (Must be ... , you will be a key member of the utilization management team. We can offer you a meaningful...a Registered Nurse ) + Strong interpersonal and communication… more
- Beth Israel Lahey Health (Cambridge, MA)
- …Minimum Qualifications: 1. Bachelor's degree preferred. 2. Current Massachusetts state license as a Registered Nurse ( RN ). 3. Two years of recent acute ... with Harvard Medical School. The Inpatient Case Manager (CM) performs utilization reviews and coordinates discharge planning for MAH inpatient admissions. Inpatient… 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
- 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
- Beth Israel Lahey Health (Burlington, 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