- Beth Israel Lahey Health (Boston, MA)
- …people's lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...required and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse ( RN ), Massachusetts +… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in ... Weekend and holiday rotations required **Job Description:** The Inpatient Registered Nurse ( RN ) Case Manager...Leads the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review… more
- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse 2...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Beth Israel Lahey Health (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... and educate to improve outcomes. -Assists with preparation and presentation of utilization review monitoring/trending reports for review with physicians… more
- Erickson Living (Peabody, MA)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... (skilled nursing, long term care, assisted living or hospital) is required. + Current Registered Nurse license for the state in which they operate. + Current… more
- Fresenius Medical Center (Medford, MA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- …Nurse Total Rewards The Community Living Center (CLC) Minimum Data Set (MDS) Registered Nurse ( RN ) is responsible for providing competent, evidence-based ... Summary The Registered Nurse -CLC Minimum Data Set position...education, orientation, competencies and providing quality improvement and outcomes utilization consultation. Demonstrates leadership in delivering and improving holistic… more
- Tufts Medicine (Lowell, MA)
- …etc.) **Job Description** **Minimum Qualifications:** 1. Bachelor's degree in Nursing (BSN). 2. Registered Nurse ( RN ) license. 3. Basic Life Support (BLS) ... **_Tufts Medicine has a new Community RN Career Pathway plan_** that allows you to...customer satisfaction, while striving for optimal efficiency, productivity, and utilization of all resources. Provides patient and staff education,… more
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …require evening, weekend and/or holiday shifts on a rotating basis. Required Qualifications: + Registered Nurse License in MA + Bachelor's degree in Nursing from ... are currently hiring a Clinical Care Manager - OBAT RN based in Framingham. As part of a team-based...self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and… more
- Sharecare (Boston, MA)
- …support appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... Hours are on Central Standard Time. **Job Summary:** The RN has the responsibility for supporting the goals and...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Beth Israel Lahey Health (Cambridge, MA)
- …annually. c. Maintains BLS, ACLS certification d. Attends Emergency Department RN Competency Review Course annually. e. Attends hospital-based Education ... difference in people's lives.** Join our team as a key Emergency Department nurse in our renovated and expanded department, caring for approximately 34,000 patients… more
- Lawrence General Hospital (Lawrence, MA)
- …acute care setting with discharge planning, continuing care, care management, and utilization review preferred. + Strong verbal and written communications skills ... The RN Care Manager collaborates with physicians, nurses, and other clinical staff/directors to coordinate, facilitate and expedite patient care services across the… more
- Commonwealth Care Alliance (Boston, MA)
- …claims adjudication, clinical coding reviews for claims, settlement, claims auditing and/or utilization review required + 7+ years experience with Optum Claims ... regulations. The role will also be responsible for timely review and research, as necessary on all new and...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- Highmark Health (Boston, MA)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management, and… more
- Erickson Living (Peabody, MA)
- …and dehydration. + Participating in Wound Rounds, Operations Meetings, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) ... and survey readiness. **What you will need** + Current RN nursing license with no restrictions for the state...3 years' experience in a healthcare leadership role (Charge Nurse , Unit Manager, etc.). + Experience with an electronic… more
- Highmark Health (Boston, MA)
- …+ Licensed Marriage and Family Therapist (LMFT) + Licensed Behavior Specialist + Registered Nurse . **Preferred** + None **SKILLS** + Working knowledge of ... Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care… more
- Beth Israel Lahey Health (Beverly, MA)
- …care givers, and families. Their functions include concurrent and retrospective review to assure appropriate utilization , assessment, prevention of denials ... school of nursing 2. BSN preferred **Certification/License:** 1. Current Massachusetts RN licensure 2. Certification in Case Management preferred **Patient Age… more
- Guardian Life (Boston, MA)
- **Position Summary** The RN Clinical Consultant serves as a clinical resource for the investigation and assessment of medical information regarding disability by ... medical reviews and analysis of long-term disability claims. The RN Clinical Consultant identifies restrictions, limitations and duration impacting functional… more
- Beth Israel Lahey Health (Wakefield, MA)
- …or Skilled Nursing Facility experience preferred. + Active, unrestricted Massachusetts Registered Nurse License required. Certification in Case Management (CCM) ... in healthy behavior. Working with the healthcare team, the Care Manager, RN monitors appropriate utilization of healthcare resources, promotes quality and… more
- Beth Israel Lahey Health (Cambridge, MA)
- …Minimum Qualifications: 1. Bachelor's degree preferred. 2. Current Massachusetts state license as a Registered Nurse ( RN ). 3. Two years of recent acute ... with Harvard Medical School. The Inpatient Case Manager (CM) performs utilization reviews and coordinates discharge planning for MAH inpatient admissions. Inpatient… more