- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring ... facilities under the provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer...**What You'll Be Doing:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… 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)
- …considered and referred as vacancies become available. This OCA may be used to fill a Registered Nurse ( RN ) position that is located in the one of following ... VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities VA offers a...CLC-2C CLC-62C CLC-62D CLC-78C The Community Living Center (CLC) Registered Nurse ( RN ) is responsible… more
- Beth Israel Lahey Health (Cambridge, MA)
- …Regular **Scheduled Hours:** 24 **Work Shift:** Rotating (United States of America) REGISTERED NURSE - EMERGENCY DEPARTMENT **Job Description:** REGISTERED ... annually. c. Maintains BLS, ACLS certification d. Attends Emergency Department RN Competency Review Course annually. e. Attends hospital-based 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...Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to Medical Assistant Treatment Program (MAT) patients. As… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a key role in ensuring CCA meets ... services, procedures, and facilities under the provisions of CCA's benefits plan. The Utilization Management (UM) Reviewer is responsible for day-to-day timely… more
- Highmark Health (Boston, MA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring ... facilities under the provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer...**What You'll Be Doing:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Tufts Medicine (Burlington, MA)
- …**Job Description** **Minimum Qualifications:** 1. Bachelor's Degree in Nursing 2. Active Registered Nurse ( RN ) license in Massachusetts or compact ... (ICU, ED, Critical Care, strong Med/Surg Specialty) or equivalent case management , utilization review , denials management , or progressive leadership… more
- Humana (Boston, MA)
- …hoc reports in Access and/or SQL + Graduate degree + Utilization Management Review Experience + Registered Nurse ( RN ) Credentials + Home Health, ... Durable Medical Equipment, and/or Skilled Nursing Facility Experience **Additional Information** **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week)… more
- Elevance Health (Woburn, MA)
- …health insurance/benefits, medical management process, care management , and utilization review management strongly preferred. For candidates working ... Case Manager II** is responsible for the Case Management and Utilization Management of...Management Exempt **Workshift:** **Job Family:** MED > Licensed Nurse Please be advised that Elevance Health only accepts… more
- Tufts Medicine (Burlington, MA)
- …**Job Description** **** **Minimum Qualifications:** 1. Associate's degree in Nursing 2. Active Registered Nurse ( RN ) license in Massachusetts or compact ... hospital setting (ICU, ED, Critical Care, strong Med/Surg Specialty) OR case management , utilization review , or denials management in an acute-care… more
- Beth Israel Lahey Health (Boston, MA)
- …in a cost-effective and quality-driven manner. **Job Description:** **A. UTILIZATION MANAGEMENT ** : Perform a 100% review of anticipated admissions utilizing ... a difference in people's lives.** The role of the RN Case Manager Emergency Department (ED) is to increase...: Three years of acute care experience **Preferred:** Case Management or Utilization Management experience… more
- Tufts Medicine (Tewksbury, MA)
- …etc.) **Job Description** **Minimum Qualifications:** 1. Bachelor's degree in Nursing (BSN). 2. Registered Nurse ( RN ) license. 3. Basic Life Support (BLS) ... expectations, continuing education, credentialing, performance appraisals, auditing, concurrent monitoring, utilization review , risk management and active… more
- Elevance Health (Woburn, MA)
- …**How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and ... **Anticipated End Date:** 2024-09-16 **Position Title:** RN Hospital Bill Audit/Appeal Lead **Job Description:** **...Management Exempt **Workshift:** **Job Family:** MED > Licensed Nurse Please be advised that Elevance Health only accepts… 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… more
- East Boston Neighborhood Health Center (East Boston, MA)
- …range planning and determining staffing needs. + Assists Home Care Manager/Residential Nurse manager to monitor utilization and processes for stocking Nursing ... in policy review and revision. Works with Home Care Director/Residential Nurse Manager to update policies, procedures and workflows as needed to ensure… more
- Beth Israel Lahey Health (Burlington, MA)
- …people's lives.** The inpatient Case Manager assigned by nursing unit coordinates utilization review , discharge planning and monitors quality assurance for Lahey ... **Essential Duties & Responsibilities including but not limited to:** 1) Performs utilization review and discharge planning to inpatient admissions. 2) Applies… more
- Lincoln Financial Group (Boston, MA)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... will provide coaching and guidance to claims regarding medical management **What you'll be doing** * Evaluate medical information...looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license… more
- Beth Israel Lahey Health (Milton, MA)
- …years prior experience in Case Management , preferred (Discharge Planning and Utilization Review + Current knowledge of federal, state, and regulatory ... clinical expertise in the development of discharge plans, applies utilization review criteria to determine medical necessity...or a related field + Current licensure as a registered nurse in the State of Massachusetts… more