- CVS Health (Concord, NH)
- …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 (Concord, NH)
- …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 (Concord, NH)
- **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
- 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
- Veterans Affairs, Veterans Health Administration (Manchester, NH)
- …knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community care ... Summary This Registered Nurse - Clinical Nurse Coordinator position is...the continuum of care, patient and family education, Veteran self- management after discharge, and supporting factors that impact customer… more
- CVS Health (Concord, NH)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… 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
- HCA Healthcare (Manchester, NH)
- …you have the PRN career opportunities as a(an) PRN House Supervisor RN Registered Nurse you want with your current employer? We have an exciting opportunity for you ... colleagues. Do you want to work as a(an) PRN House Supervisor RN Registered Nurse where your passion for creating positive patient interactions is valued? If you are… more
- Evolent (Concord, NH)
- …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
- Lawrence General Hospital (Methuen, MA)
- …experience in an acute care setting with discharge planning, continuing care, care management , and utilization review preferred. ? Strong verbal and written ... assigned to selected areas of the Hospital on a rotating basis to perform utilization reviews and other UM activities, as needed, to be based upon department… more
- Fresenius Medical Center (Lowell, MA)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Lawrence General Hospital (Methuen, MA)
- …experience in an acute care setting with discharge planning, continuing care, care management , and utilization review preferred. + Strong verbal and written ... communications skills + Proficiency with computers and an ability to learn new programs with ease. 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
- Beth Israel Lahey Health (Burlington, MA)
- …of three years of medical/surgical nursing care experience. Two years of case management or utilization management experience desirable. * Demonstrated ... and within the Lahey Clinic Professional Practice Model, MA Nurse Practice Act and ANA Standards of Practice and...needed. 10) Supports all service line activities related to utilization and quality management . 11) Assists in… more
- Tufts Medicine (Lowell, MA)
- …with agency policy, State and federal home health regulations. Responsible for the management of cost effective, efficient care to home health and hospice patients ... Hours)** **Job Description** **Minimum Qualifications:** 1.Current licensure as a Registered Nurse or Physical Therapist. 2. Massachusetts RN Licensure OR Physical… more
- Tufts Medicine (Lowell, MA)
- …with agency policy, State and federal home health regulations. Responsible for the management of cost effective, efficient care to home health patients ensuring the ... **Minimum Qualifications** **:** 1. Current licensure as a Registered Nurse or Physical Therapist. **Preferred Qualifications** **:** 1. Bachelor's prepared… more
- HCA Healthcare (Derry, NH)
- …Registered Nurse license + Two or more years of clinical experience. + Case Management , Utilization & Managed Care experience and 1 or more years of ... medical necessity, admission status, level of care, and resource management . + The RN Case Manager Team Lead will...supporting a balance of optimal care and appropriate resource utilization . + The RN Case Manager Team Lead will… more
- Intermountain Health (Concord, NH)
- …+ Care Management Certification + Demonstrated experience in case management , utilization review, or discharge planning. + Bi-Lingual/Spanish Speaking ... The RN Ambulatory Care Manager I delivers comprehensive ambulatory care management services to identified patients. Leveraging clinical expertise, this role involves… more
- Sharecare (Concord, NH)
- …/ 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