- 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
- 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
- CVS Health (Woonsocket, RI)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Dana-Farber Cancer Institute (Foxborough, 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
- Brockton Hospital (Brockton, MA)
- …patient care in a healing, humane, and caring environment. + Research: uses clinical inquiry in practice + Resource Utilization : considers factors related to ... Registered Nurse (RN), Part- Time Flex Nights, A2-Telemetry Signature...encompassing nursing, hospitalists, social work, physical therapy, and case management , we strategize patient discharge plans. The unit handles… more
- Evolent (Providence, RI)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Brockton Hospital (Brockton, MA)
- …patient care in a healing, humane, and caring environment. + Research: uses clinical inquiry in practice + Resource Utilization : considers factors related to ... Registered Nurse (RN), Part-Time, Flex, Nights, 8 Hour Shift,...than ever. Telemetry Support staff include unit secretaries and clinical care assistants. A2 admits patients primarily from the… more
- Brockton Hospital (Brockton, MA)
- …responsibilities include the development and supervision of staff (RNs, LPN's,SWs and non- clinical support), evaluation and maintenance of case management skills ... include the development and supervision of staff (RNs, LPN's, SWs and non- clinical support), evaluation and maintenance of case management skills 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
- Point32Health (Canton, MA)
- …and disease/chronic condition management per department guidelines. The nurse care manager possesses strong clinical knowledge, critical thinking ... with the interdisciplinary care team, to improve member outcomes (ie, Utilization Management , Medical Director, pharmacy, community health workers, dementia… 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
- 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
- Brockton Hospital (Brockton, MA)
- …Must have current license from Commonwealth of Massachusetts to practice as a Registered Nurse . Minimum of five years clinical experience in an acute care ... primary care physicians (PCP's) as well as other hospital clinical and administrative staff to develop and implement effective...facility required. Prior experience in case management , utilization review or discharge planning… more