- Beth Israel Lahey Health (Boston, MA)
- …lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... the level of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …medical necessity criteria and BCBSMA policies and procedures + Focus on efficient utilization management with emphasis on discharge planning + Understand and ... to obtain and/or share information relating to benefits and the BCBSMA utilization management process + Collaborate with members/families, providers, medical… more
- Beth Israel Lahey Health (Milton, MA)
- …lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... the level of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure… more
- Beth Israel Lahey Health (Cambridge, MA)
- …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 ... to older adults. **Job Description:** **Primary Responsibilities** 1. The emergency nurse initiates accurate and ongoing assessment of physical, psychological and… more
- Cambridge Health Alliance (Cambridge, MA)
- …team leader in multi-disciplinary team discussion regarding treatment planning, treatment review , quality assurance and utilization review ... Nurse Practitioner - Clinical Specialist II (APRN), Psychiatry...to nursing policy and procedure. + Communicate effectively with management , peers, and health team members. + Interact effectively… more
- Brockton Hospital (Brockton, MA)
- … management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience ... delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare… more
- Beth Israel Lahey Health (Plymouth, MA)
- …3) Decreasing unit cost, 4) reducing readmissions. **Functions and Responsibilities:** **A. Utilization Management ** + Performs review of anticipated ... patient care status. This role is structured around four major functions + Utilization Management + Care Coordination + Discharge Planning + Preventing… more
- Evolent (Boston, MA)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… 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
- GE Vernova (Foxborough, MA)
- …expeditor of actions. + Hold operating rhythm, pacing calls on Resource/workload management , Engineering utilization , Budget Deviation, On Time Delivery (OTD), ... Customer comments. + Collaborate with Project Controls to have monthly rhythm to review workload vs capacity and work with department managers on their respective… more
- Cambridge Health Alliance (Cambridge, MA)
- …a business card. * Integrates the discharge planning/coordination and utilization review functions in the case management role. * Refers appropriate cases ... hours of admission utilizing specific criteria to identify needs related to utilization management and/or discharge planning. Refers appropriate cases to Social… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …**Minimum Experience:** + 1 year of clinical and/or related experience required. Case Management , Utilization Review and/or Prior Authorization experience is ... complex inquiries. + Assists Drug Authorization Specialists with medical necessity denial review : + Ensures that all necessary medical information was provided to… more
- Brockton Hospital (Brockton, MA)
- …of five years clinical experience in an acute care facility required. Prior experience in case management , utilization review or discharge planning required. ... Provides medical-surgical pediatric and obstetrical case management services to Brockton Hospital patients. Responsible for assuring continuity of care for patients… more
- Harvard University (Cambridge, MA)
- …quality projects, daily huddles, Lean activities, and other continuing education, utilization management , and other departmental activities. + Fosters positive ... sponsorship. + This position has a 90-day orientation and review period. Department:Urgent CarePre-Employment Screening:Criminal, Education, IdentitySchedule: Schedule Week… more
- Erickson Living (Hingham, MA)
- …of medical practice; insurance benefit structures and related legal/medical issues; and utilization review and quality assurance procedures. Please note that ... + Researches and selects care options as appropriate. The nurse care coordinator may utilize a range of alternative,...health nursing, home health care) and/or 3 years case management and/or UR experience preferred. + Knowledge of health… more
- The Home for Little Wanderers (Dorchester, MA)
- …documentation and billing in a timely manner. Ensure that documentation meets utilization review and quality assurance standards. + Attend in-service training ... Therapy, Family Partners, Young Adult Peer Mentor, Vocational Specialists, and Psychiatrists/ Nurse Prescribers to help support growth and recovery for youth and… more