- Cognizant (Boston, MA)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… 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
- Beth Israel Lahey Health (Burlington, MA)
- …weekends. This position is on-site at Lahey Hospital and Medical Center. The Utilization Analyst works with physicians, the payers and inpatient case management ... medical necessity of the hospital care. Using the concepts of utilization review, clinical documentation improvement and revenue integrity, these specialized case… more
- Fenway Health (Boston, MA)
- Registered Nurse Boston, MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing Job Type Full-time Description As a Registered Nurse ... care to individuals, families, communities, and patient populations. The Registered Nurse 's care delivery is consistent with the Massachusetts Board of Registration… more
- Lawrence General Hospital (Lawrence, MA)
- …referrals and facilitates appropriate discharge plans. + Works in conjunction with Utilization Review Nurse , Social Worker and Clinical Care Leader to ... experience in an acute care setting with discharge planning, continuing care, care management , and utilization review. + Five years clinical nursing experience… 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 (Chelmsford, 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
- Massachusetts Institute of Technology (Cambridge, MA)
- …patients, families, providers, and community agencies. PREFERRED: two years of case management , utilization review, and discharge planning experience. 11/18/2025 ... Registered Nurse , Care Coordinator + Job Number: 25320 +...a Friend Save Save Apply Now Posting Description REGISTERED NURSE , CARE COORDINATOR, MIT Health, will serve as a… more
- CVS Health (Boston, MA)
- …health outcomes by engaging telephonically with individuals living with diabetes. This nurse will guide members through actionable steps to close gaps in care, ... education, connecting members to resources, and facilitating referrals to care management programs for continued support. This position supports the development and… more
- Evolent (Boston, MA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Atrius Health (Newton, MA)
- …. Minimum 5 years nursing experience, which includes a minimum of 3 years in utilization management or case management . . Minimum of 3-5 years clinical ... health and welfare benefit package. **Job:** **Nursing* **Organization:** **Case Management * **Title:** *CMRN-Ambulatory Nurse Case Manager (MNA)* **Location:**… more
- Beth Israel Lahey Health (Cambridge, MA)
- …with Harvard Medical School. The Inpatient Case Manager (CM) performs utilization reviews and coordinates discharge planning for MAH inpatient admissions. Inpatient ... Case Manager Guidelines and audit tool. Reports to Inpatient Case Management Supervisor. **Job Description:** **Essential Duties & Responsibilities (including but… 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 (Wakefield, MA)
- …population health and is responsible to ensure that quality and efficient care management services are provided to the BILHPN provider's risk populations. The Care ... Manager provides care management services to the BILHPN primary care physicians focusing...focusing care coordination attention on the at-risk population driving utilization and costs to improve efficiency, quality and patient… more
- Fresenius Medical Center (Medford, MA)
- …staff training, equipment, physician and patient relations, cost containment, supply management , medical records, patient billing, OSHA and all company, state and ... by working with the Vice President of Quality and other organization management to ensure that organization/ASC policies and procedures are followed. + Responsible… more
- Fresenius Medical Center (Lowell, MA)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Cambridge Health Alliance (Cambridge, MA)
- …**Work Days** : Mon-Fri; 8:00-4:30, rotating weekends and holidays **Category** : Registered Nurse **Department** : Inpatient Case Management CH **Job Type** : ... RN Case Manager - Inpatient Case Management CH **Requisition Number:** 10782 **Pay Range:** $41.58...members of the health care team to identify appropriate utilization of resources and to ensure reimbursement. Utilize criteria… more
- Cambridge Health Alliance (Somerville, MA)
- …**Work Days:** Mon-Fri; 8:00-4:30, rotating weekends and holidays **Category:** Registered Nurse **Department:** Inpatient Case Management SH **Job Type:** Per ... RN Case Manager - Inpatient Case Management SH **Requisition Number:** 10379 **Pay Range:** $41.58...members of the health care team to identify appropriate utilization of resources and to ensure reimbursement. Utilize criteria… 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