- Humana (Providence, RI)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CenterWell (Providence, RI)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Evolent (Providence, RI)
- … Reviewer, Nurse , you will routinely interact with leadership and management staff, other CR's ( Clinical Reviewers), providers, office staff and Field ... culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse , you will be a..., you will be a key member of the utilization management team. We can offer you… more
- Evolent (Providence, RI)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Dana-Farber Cancer Institute (Attleboro, MA)
- …Director of Nursing is responsible for the planning, implementation and evaluation of clinical operations and personnel management of the assigned patient care ... the highest quality patient experience while maximizing provider time and space utilization . The Nurse Director uses extensive theoretical, evidence-based, and… more
- Atrius Health (Easton, MA)
- …of the Department Chief, Nurse Leader or designee, this registered professional nurse provides practice support to a clinical team, recognizing the patient ... 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
- Edwards Lifesciences (Providence, RI)
- …post-case management , 3 Mensio management , Therapy Awareness program management and clinical education programs. + Implementing sales and educational ... and implementing growth strategies within focused accounts in partnership with Sales Management . + Developing clinical champions among current and potential… more
- Edward M. Kennedy Community Health Center, Inc. (Milford, MA)
- …Requirements: + Registered Nurse License in MA + 1-2 years of clinical experience + Current CPR certification. Benefits: + Competitive salary based on related ... to support this growth. We are currently hiring a Clinical Care Manager based in Milford, MA. The ...Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to chronic disease patients, especially to those who… more
- Charter Care Health Partners (North Providence, RI)
- …Continuum of Care Management (Discharge planning) and Clinical Documentation Management . Collects data via utilization with Care Port to enhance the ... residency if that state is a member of the Nurse Licensure Compact. Five (5) years of clinical...clinical experience that includes recent experience with case management , patient navigation, case management , utilization… more
- Charter Care Health Partners (North Providence, RI)
- …Continuum of Care Management (Discharge planning) and Clinical Documentation Management . Collects data via utilization with Care Port to enhance the ... residency if that state is a member of the Nurse Licensure Compact. Five (5) years of clinical...clinical experience that includes recent experience with case management , patient navigation, case management , utilization… more
- Highmark Health (Providence, RI)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... Nursing **EXPERIENCE** **Required** + 3 years of related, progressive clinical experience in the area of specialization + Experience...is part of the compact **Preferred** + Certification in Utilization Management or a related field **SKILLS**… more
- Datavant (Providence, RI)
- …function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal ... The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity and… more
- Sharecare (Providence, RI)
- …3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case ... / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical,… more
- Oracle (Providence, RI)
- …of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will ... These include, but are not limited to, multiple Essential Clinical Dataset (ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding,… more
- Genesis Healthcare (Middletown, RI)
- …Regional Management and AlignMed Partners to oversee the implementation, utilization , and outcomes measurement of AlignMed Partners Clinical Programs. The ... in Middletown, RI. This is a Dual Role Attending Physician/Medical Director. It is clinical in nature. Must be BC/BE Internal Medicine or Family Medicine with LTC… more
- Highmark Health (Providence, RI)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...- 5 years of related, progressive experience in a clinical setting **Preferred** + 1-3 years of experience in… more
- Genesis Healthcare (Middletown, RI)
- …with assigned Centers and AlignMed Partners managers to oversee the implementation, utilization , and outcomes measurement of AlignMed Partners Clinical Programs ... in Middletown, RI. This is a Dual Role Attending Physician/Medical Director. It is clinical in nature. Must be BC/BE Internal Medicine or Family Medicine with LTC… more