- VitalCore Health Strategies (Hopkinton, MA)
- …Animal/Pet Insurance Employee Assistance Program and Discount Center 401K EEO Keywords: Utilization Management , RN , Nurse , Administrative, #INDMA ... in Correctional Healthcare, has a Full-Time opening for a Utilization Management RN at the...of an accredited School of Nursing Licensure as a Registered Nurse in the state of employment… more
- Humana (Providence, RI)
- **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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- CVS Health (Woonsocket, RI)
- …active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, ... all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and...**Required Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care… more
- CenterWell (Providence, RI)
- … RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... program that enhances the quality of patient care while optimizing resource utilization . Provides training to staff on case management methods and techniques.… more
- Brockton Hospital (Brockton, MA)
- Registered Nurse ( RN ), Part- Time Flex Nights, A2-Telemetry Signature Healthcare's Brockton Hospital is hiring for a Part Time Flex Registered Nurse ... available during off-shifts to enhance patient care, staffing, and throughput coordination. Registered Nurse ( RN ) Roles and Responsibilities: + Assessment:… more
- Brockton Hospital (Brockton, MA)
- Registered Nurse ( RN ), Part-Time, Flex, Nights, 8 Hour Shift, Telemetry Signature Healthcare's Brockton Hospital is hiring for a Part-Time, Flex, 8 Hour ... Shift, Registered Nurse ( RN ) for Telemetry...nursing, the hospitalist team, social work, physical therapy, case management to plan for patient discharge. The majority of… more
- Fallon Health (Worcester, MA)
- … Nurse in a clinical setting required. * 2 years' experience as a Utilization Management /Prior Authorization nurse in a managed care payer preferred. * ... degree in nursing required **License/Certifications:** Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience:** * A minimum of… more
- Fenway Health (Boston, MA)
- …MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing Job Type Full-time Description As a Registered Nurse ( RN ) at Fenway Health ... to the care team with primary responsibilities for disease management , care coordination, and advice/triage needs for the care...+ Education: Associate degree in nursing + Current Massachusetts Registered Nurse ( RN ) license degree… more
- Beth Israel Lahey Health (Needham, MA)
- …practice model. **Job Description:** **Essential Responsibilities:** 1. Performs utilization management , care coordination, and discharge planning ... 40 hr (every third weekend & rotating holiday required) Job Summary: The RN Case Manager (CM) facilitates the coordination of care for those patients admitted… more
- Beth Israel Lahey Health (Boston, MA)
- …quality indicators such as avoidable delays, length of stay, resource utilization , patient satisfaction, patient flow, outlier management , and readmissions ... job, you're making a difference in people's lives.** The RN Case Manager working in the Triad Model of...of efficient, high-quality care. This position ensures the appropriate utilization of clinical resources with a goal of a… more
- Fresenius Medical Center (Providence, RI)
- …and post procedure, under the direction of the Facility Manager and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in ... acting on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other FVC administrative and… more
- Atrius Health (Dedham, MA)
- …and welfare benefit package. **Job:** **Nursing* **Organization:** **Internal Medicine* **Title:** * Registered Nurse (MNA) Internal Medicine - Dedham - Full ... *SUMMARY * Under the direction of the Department Chief, Nurse Leader or designee, this registered professional...This position is responsible for effective care delivery and management of patient care within a specialty, utilizing the… more
- Point32Health (Canton, MA)
- …with the interdisciplinary care team, to improve member outcomes (ie, Utilization Management , Medical Director, pharmacy, community health workers, dementia ... Qualifications - what you need to perform the job Certification and Licensure + Registered Nurse with current unrestricted license in state of residence + May… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. * Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management * Serve as the primary relationship manager and point of contact… more
- Commonwealth Care Alliance (Boston, MA)
- …delegated partnerships programs, working with clinical community partners responsible for care management and utilization management across CCA's One Care ... & Language (nice to have): * Familiarity with care management and utilization management systems...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- Highmark Health (Providence, RI)
- …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...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- Elevance Health (Boston, MA)
- …facility-based and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience; or any combination of education and ... + Supporting frontline staffing, coaching, mentoring through 1:1s and Performance management . + Partnering with Quality and Training teams. + Attending meetings… more
- Charter Care Health Partners (North Providence, RI)
- …Graduate of a School of Nursing (BSN preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in the nurse 's ... specific patient population. Performs functions related to Patient Advocacy; Utilization Review; Resource Management ; Continuum of Care...residency if that state is a member of the Nurse Licensure Compact. Five (5) years of clinical experience… more
- Charter Care Health Partners (North Providence, RI)
- …Graduate of a School of Nursing (BSN preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in the nurse 's ... specific patient population. Performs functions related to Patient Advocacy; Utilization Review; Resource Management ; Continuum of Care...residency if that state is a member of the Nurse Licensure Compact. Five (5) years of clinical experience… more
