- Humana (Concord, NH)
- …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
- 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, ... holidays, and evening hours. * Utilizes clinical experience and skills in a collaborative process to...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 to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Evolent (Concord, NH)
- …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
- Fresenius Medical Center (Lowell, MA)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… 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 ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Lawrence General Hospital (Lawrence, MA)
- …appropriate discharge plans. + Works in conjunction with Utilization Review Nurse , Social Worker and Clinical Care Leader to ensure all appropriate ... care setting with discharge planning, continuing care, care management , and utilization review. + Five years clinical nursing experience required +… more
- HCA Healthcare (Manchester, NH)
- …knowledge and expertise! **Job Summary and Qualifications** The House Supervisor/Bed Management Coordinator provides clinical supervision, leadership and support ... career opportunities as a(an) PRN House Supervisor RN Registered Nurse you want with your current employer? We have...meetings with hospital staff to identify and communicate bed utilization issues . With inpatient coordinators and clinical… more
- Atrius Health (Chelmsford, MA)
- …of the Department Chief, Nurse Leader or designee, this registered professional nurse provides practice support to a clinical team, recognizing the patient ... 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
- Tufts Medicine (Lowell, MA)
- …to weekend clinical and administrative staff. + Provides the direct management of the Weekend clinical staff, schedulers, intake supervisor and Weekend ... State and federal home health regulations. Responsible for the management of cost effective, efficient care to home health...regarding pre and post weekend follow-up. + Promotes efficient utilization of resources to achieve desired clinical … more
- Lawrence General Hospital (Methuen, MA)
- …for this advanced degree) ? Current Massachusetts Nursing license ? Minimum 5 years clinical nursing experience ? 5 years case management experience in an acute ... hospital and being held accountable for appropriate financial and clinical outcomes of these patients. The RN Care Coordinator...care setting with discharge planning, continuing care, care management , and utilization review preferred. ? Strong… more
- Tufts Medicine (Lowell, MA)
- … such as interviewing, hiring, and disciplinary action. + Promotes efficient utilization of resources to achieve desired clinical outcomes and within ... with agency policy, State and federal home health regulations. Responsible for the management of cost effective, efficient care to home health patients ensuring the… more
- Lawrence General Hospital (Methuen, MA)
- …Master's degree preferred + Current Massachusetts Nursing license + Minimum 5 years clinical nursing experience + 5 years case management experience in an ... acute care setting with discharge planning, continuing care, care management , and utilization review preferred. + Strong verbal and written communications skills… more
- Beth Israel Lahey Health (Exeter, NH)
- …as evidenced by staff and patient survey results. 10. Works together with the Clinical Nurse educators to ensure clinical competencies for staff. Equal ... Clinical Practice Supervisor-Core Family & Internal Medicine +...within 6 months of hire . Completion of required management training courses within 1 year of hire **Responsibilities:**… more
- HCA Healthcare (Derry, NH)
- …or compact state Registered Nurse license + Two or more years of clinical experience. + Case Management , Utilization & Managed Care experience and ... care with a focus on evaluating the appropriateness of clinical care, medical necessity, admission status, level of care,...medical necessity, admission status, level of care, and resource management . + The RN Case Manager Team Lead will… more
- Sharecare (Concord, NH)
- …3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case ... / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical,… more
- Oracle (Concord, NH)
- …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 (Concord, NH)
- …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
- Dartmouth Health (Hampstead, NH)
- …through the organization to promote functioning of hospital operations, including bed utilization . * Coordinates allocation of material resources. * Serves as an ... arbitrator for conflicts that arise on assigned shift. Facilitates short-term management of conflict and communicates to the appropriate departmental leadership for… more
- Veterans Affairs, Veterans Health Administration (Manchester, NH)
- … nurse practitioners, physician assistants, psychologists, psychiatrists, social workers, clinical pharmacists, and nursing staff) to accomplish team goal setting ... include, but are not limited to: Supports clinics regarding clinic profile management . Collects and updates insurance information from Veterans, family members and… more