- 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 (Providence, RI)
- …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
- Humana (Providence, RI)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Brockton Hospital (Brockton, MA)
- Registered Nurse (RN), Part- Time Flex Nights, A2-Telemetry Signature Healthcare's Brockton Hospital is hiring for a Part Time Flex Registered Nurse (RN) for ... rounds encompassing nursing, hospitalists, social work, physical therapy, and case management , we strategize patient discharge plans. The unit handles a spectrum… more
- Evolent (Providence, RI)
- …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
- Dana-Farber Cancer Institute (Attleboro, MA)
- …the highest quality patient experience while maximizing provider time and space utilization . The Nurse Director uses extensive theoretical, evidence-based, and ... for the planning, implementation and evaluation of clinical operations and personnel management of the assigned patient care unit. He/she acts as a liaison… more
- Brockton Hospital (Brockton, MA)
- Registered Nurse (RN), Part-Time, Flex, Nights, 8 Hour Shift, Telemetry Signature Healthcare's Brockton Hospital is hiring for a Part-Time, Flex, 8 Hour Shift, ... Registered Nurse (RN) for Telemetry in Brockton, MA. Type: Part-Time,...nursing, the hospitalist team, social work, physical therapy, case management to plan for patient discharge. The majority of… more
- Fresenius Medical Center (Providence, RI)
- …procedure, under the direction of the Facility Manager and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in optimum ... acting on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other FVC administrative and… more
- Brockton Hospital (Brockton, MA)
- … program that enhances the quality of patient care while optimizing resource utilization . Provides training to staff on case management methods and techniques. ... and develops reports that clearly monitor all areas of utilization /case management . Provides data, guidance and input...RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It… more
- Charter Care Health Partners (North Providence, RI)
- …of a specific patient population. Performs functions related to Patient Advocacy; Utilization Review; Resource Management ; Continuum of Care Management ... and Clinical Documentation Management . Collects data via utilization with Care Port to enhance the quality and...preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in… more
- Charter Care Health Partners (North Providence, RI)
- …of a specific patient population. Performs functions related to Patient Advocacy; Utilization Review; Resource Management ; Continuum of Care Management ... and Clinical Documentation Management . Collects data via utilization with Care Port to enhance the quality and...preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in… more
- Sharecare (Providence, RI)
- …/ 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
- Highmark Health (Providence, RI)
- …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
- Edwards Lifesciences (Providence, RI)
- …an impact:** + Working independently in the areas of valve crimping, case management , pre-case planning, post-case management , 3 Mensio management , Therapy ... implementing growth strategies within focused accounts in partnership with Sales Management . + Developing clinical champions among current and potential customers… more
- Brockton Hospital (Brockton, MA)
- …of five years clinical experience in an acute care facility required. Prior experience in case management , utilization review or discharge planning required. ... of our patients. Provides medical-surgical pediatric and obstetrical case management services to Brockton Hospital patients. Responsible for assuring continuity… more
- Oracle (Providence, RI)
- …alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal candidate ... sessions, and offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report progress to… more
- Edward M. Kennedy Community Health Center, Inc. (Milford, MA)
- …The Clinical Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to chronic disease patients, especially to those who are most at ... patients, ensuring optimal care including acute illness and chronic disease management , lifestyle and behavior education, and preventive care across multiple health… more
- Humana (Providence, RI)
- …inpatient and subacute activity daily for outcomes related to readmission, utilization , quality of care and provider performance in compliance with Humana/iCare ... your skills to make an impact** **Required Qualifications** + Licensed as a Registered Nurse in the State of Wisconsin, including compact license. + Two (2) or more… more