- Commonwealth Care Alliance (Boston, MA)
- …Group **Position Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director ... more
- Beth Israel Lahey Health (Burlington, MA)
- …in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse ( RN ) Case ... more
- Beth Israel Lahey Health (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... more
- Tufts Medicine (Lowell, MA)
- …with EVD, IABP and Impella patients. The Clinical Leader of ICU-G is a Registered Nurse with responsibility and accountability for the coordination of clinical ... more
- Erickson Living (Peabody, MA)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... more
- Cambridge Health Alliance (Cambridge, MA)
- …Days:** Varied 8 hr shifts working a biweekly average of 36 hrs. **Category:** Registered Nurse **Department:** Office Based Opioid Grant **Job Type:** Full time ... 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 ... more
- Beth Israel Lahey Health (Cambridge, MA)
- …needs throughout the spectrum of life, from pediatrics to older adults. **Job Description:** Registered Nurse - Sign on Bonus eligibility up to $10,000 **Primary ... more
- Tufts Medicine (Lowell, MA)
- …etc.) **Job Description** **Minimum Qualifications:** 1. Bachelor's degree in Nursing (BSN). 2. Registered Nurse ( RN ) license. 3. Basic Life Support (BLS) ... 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 ... more
- Beth Israel Lahey Health (Newburyport, MA)
- …experience in the acute care setting and previous case management experience, utilization review and/or discharge planning experience is required. **Required ... more
- Humana (Boston, MA)
- …are currently living in Puerto Rico. + A current, valid and unrestricted license as a Registered Nurse ( RN ) + 2 years case management experience + An active ... more
- Lawrence General Hospital (Lawrence, MA)
- …acute care setting with discharge planning, continuing care, care management, and utilization review preferred. + Strong verbal and written communications skills ... 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 ... more
- Highmark Health (Boston, MA)
- …+ Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN ... more
- Dana-Farber Cancer Institute (Brookline, MA)
- …+ 1 year of clinical and/or related experience required. Case Management, Utilization Review and/or Prior Authorization experience is preferred. + ... more
- Commonwealth Care Alliance (Boston, MA)
- …claims adjudication, clinical coding reviews for claims, settlement, claims auditing and/or utilization review required + 7+ years experience with Optum Claims ... more
- Erickson Living (Peabody, MA)
- …and dehydration. + Participating in Wound Rounds, Operations Meetings, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) ... more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …What You Bring : + Behavioral Health professional with an active Massachusetts license: Registered Nurse , LICSW, LMHC + 3-5 years of clinical experience in ... more
- Highmark Health (Boston, MA)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... more