- Children's Hospital Boston (Boston, MA)
- …Planning and or Utilization Management ) preferred. Office/Site Location:BostonRegular, Temporary, Per Diem:Per Diem Remote Eligibility :Onsite Only ... 74825BRJob Posting Title: Registered Nurse Case Manager, Inpatient &...per Week:1 Job Posting Category:NursingJob Posting Description:The Per Diem RN Case Manager (inpatient and/or ambulatory) will be responsible… 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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Conduct pre-certification, concurrent, and retrospective reviews with emphasis on utilization management , discharge planning, care coordination, clinical ... Mobile, and Resident personas. This position can be fully remote , with a 1x/month staff meeting in our Hingham,...settings (Inpatient, outpatient, or differing levels of care). + Utilization Management experience, preferred + Experience with… more
- Highmark Health (Boston, MA)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- Atrius Health (Boston, MA)
- …Clinical Director, Nurse Leader or designee, the professional licensed registered nurse provides patient centric, after-hours phone and/or telehealth support ... records system required. *REQUIRED HOURS:* * * *Full time remote Pedi RN 3pm-11:30pm AND 3.0 FTE...Avaya phone system, Outlook, QGenda scheduling, and pdf documentation management . . Remote workers must adhere to… more
- Guardian Life (Boston, MA)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...plan and length of disability. Plan for ongoing case management through proactive partnering with treating providers to move… more
- Erickson Living (Hingham, MA)
- …patient-specific outcomes. + Researches and selects care options as appropriate. The nurse care coordinator may utilize a range of alternative, non-medical services ... based on experience* **Schedule** : M-F 830A-5PM on site. Remote not available. **What you will need** + Active...available. **What you will need** + Active Professional Licensed RN required. CCM certification or working toward. + Minimum… more
- Beth Israel Lahey Health (Wakefield, MA)
- …Facility experience preferred. + Active, unrestricted Massachusetts Registered Nurse License required. Certification in Case Management (CCM) preferred. ... making a difference in people's lives.** The Care Manager, RN provides care management services to the...behavior. Working with the healthcare team, the Care Manager, RN monitors appropriate utilization of healthcare resources,… more
- Point32Health (Canton, MA)
- …with the interdisciplinary care team, to improve member outcomes (ie, Utilization Management , Medical Director, pharmacy, community health workers, dementia ... trends in the communities we serve. **Education, Certification and Licensure** + Registered Nurse with current unrestricted license in state of residence… more
- Humana (Boston, MA)
- …your skills to make an impact** **Required Qualifications** + Associate degree + Active Registered Nurse , ( RN ), License in your state of residence without ... project management and/or process improvement experience + Minimum 3 years utilization management experience with exposure to grievance and appeals +… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Provides telephone triage and crisis intervention when situation warrants, collaborating with utilization management peers when appropriate We're Looking for: + ... Mobile, and Resident personas. This position can be fully remote , with a 1x/month staff meeting in our Hingham,...Minimum 3-5 years working as a LICSW, LMHC or Registered Nurse + Active Massachusetts License is… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be ... based on financial ability and forecasting for small to large Operations Management + Collaborate system and data configuration into CES (Claims Editing System)… more