- CVS Health (Concord, NH)
- …we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical skills to ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… 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
- 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 ... 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
- 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
- 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
- GE Aerospace (Hooksett, NH)
- …within manufacturing lines to achieve Operating goals using **KPI-based** performance management . + **Coach and Collaborate** with all levels of the organization ... of Lean principles. + Partner, develop and execute standard **Capacity Utilization ** process in partnership with the local Operations, Lean and Industrial… more
- Datavant (Concord, NH)
- …function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in… 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 ... 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
- 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
- Beth Israel Lahey Health (Exeter, NH)
- …collaboration . BCLS within 6 months of hire . Completion of required management training courses within 1 year of hire **Responsibilities:** 1. Provides oversight ... staffing to maintain smooth patient flow. 2. Responsible for human resource management of department staff including hiring, firing, evaluating, and development in… more
- Veterans Affairs, Veterans Health Administration (Manchester, NH)
- …include, but are not limited to: Supports clinics regarding clinic profile management . Collects and updates insurance information from Veterans, family members and ... the data into VISTA if applicable. Promotes Veterans registration for and utilization of MyHealthyVet (MHV) and kiosks usage. Follows procedures regarding Community… more