- CVS Health (Woonsocket, RI)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- CenterWell (Providence, RI)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Providence, RI)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… 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. * ... Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests (prior-authorizations),… more
- Beth Israel Lahey Health (Burlington, MA)
- …weekends. This position is on-site at Lahey Hospital and Medical Center. The Utilization Analyst works with physicians, the payers and inpatient case management ... medical necessity of the hospital care. Using the concepts of utilization review, clinical documentation improvement and revenue integrity, these specialized case… more
- Baystate Health (Springfield, MA)
- …Midpoint - Maximum $46.22 - $53.13 - $62.85 **Per Diem Hospital Case Manager / Utilization Management ** The **RN Hospital Case Manager** is a registered nurse ... MD's about safe plan for transitions + Leads the team to ensure appropriate utilization of patient resources and directs care to other settings when appropriate +… more
- Fenway Health (Boston, MA)
- Registered Nurse , Per Diem Boston, MA (http://maps.google.com/maps?q=1340+Boylston+St+Boston+MA+USA+02215) * Nursing Job Type Part-time Description As a Registered ... Nurse (RN) at Fenway Health you will provide compassionate,...to the care team with primary responsibilities for disease management , care coordination, and advice/triage needs for the care… more
- Baystate Health (Springfield, MA)
- … driven change projects including activity/mobility tool, acuity based assignments, capacity management workflow, and foley utilization . + The Manager is ... - Maximum $31.15 - $35.81 - $42.36 **Licensed Practical Nurse (LPN), Inpatient Medical Telemetry Unit** Baystate Health, a...Excellence is looking for a medical inpatient Licensed Practical Nurse to join our team in Springfield, MA. A… more
- Dana-Farber Cancer Institute (Boston, MA)
- The Nurse Director for Care Coordination directs and oversees a team responsible for patient care coordination, including utilization review, intake or discharge ... including other Harvard Medical School-affiliated hospitals. **Leadership and Team Management :** Effective leadership in nursing involves creating a positive work… more
- Beth Israel Lahey Health (Cambridge, MA)
- …completed). **KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED** 1. RN with experience in risk management , quality assessment, or utilization management . 2. Strong ... to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by leading the… more
- Evolent (Providence, RI)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Baystate Health (Springfield, MA)
- … driven change projects including activity/mobility tool, acuity based assignments, capacity management workflow, and foley utilization . + The Manager is ... Hospital for Nursing Excellence is looking for a medical inpatient Licensed Practical Nurse to join our team in Springfield, MA. **Our medical unit offers… more
- Dana-Farber Cancer Institute (Attleboro, MA)
- …the highest quality patient experience while maximizing provider time and space utilization . The Nurse Director uses extensive theoretical, evidence-based, and ... for the planning, implementation and evaluation of clinical operations and personnel management of the assigned patient care unit. He/she acts as a liaison… more
- Atrius Health (Chelmsford, MA)
- …Growing together.* *SUMMARY * Under the direction of the Department Chief, Nurse Leader or designee, this registered professional nurse provides practice ... across the lifespan. This position is responsible for effective care delivery and management of patient care within a specialty, utilizing the nursing process and… more
- Baystate Health (Springfield, MA)
- … driven change projects including activity/mobility tool, acuity based assignments, capacity management workflow, and foley utilization . + The Manager is ... a Magnet Hospital for Nursing Excellence is looking for a medical inpatient Registered Nurse to join our team in Springfield, MA. At Baystate Health, RN means more.… more
- Baystate Health (Springfield, MA)
- …nurse driven change projects including activity/mobility tool, acuity-based assignments, capacity management workflow, and foley utilization . + The Manager is ... Hospital for Nursing Excellence is looking for a medical telemetry inpatient Registered Nurse to join our team in Springfield, MA. At Baystate Health, RN means… more
- Massachusetts Institute of Technology (Cambridge, MA)
- …patients, families, providers, and community agencies. PREFERRED: two years of case management , utilization review, and discharge planning experience. 11/18/2025 ... Registered Nurse , Care Coordinator + Job Number: 25320 +...a Friend Save Save Apply Now Posting Description REGISTERED NURSE , CARE COORDINATOR, MIT Health, will serve as a… more
- Trinity Health (Springfield, MA)
- …BSN graduate preferred. + **Licensure** : Current Licensure as a Registered Nurse RN in Massachusetts. + **Certification** : BLS (AHA/ARC). Certification in Case ... Management (ACM, CCM) required within one year of employment...experience in an acute care facility or public health nurse setting. + Including an in-depth understanding of and… more
- Atrius Health (Newton, MA)
- …. Minimum 5 years nursing experience, which includes a minimum of 3 years in utilization management or case management . . Minimum of 3-5 years clinical ... health and welfare benefit package. **Job:** **Nursing* **Organization:** **Case Management * **Title:** *CMRN-Ambulatory Nurse Case Manager (MNA)* **Location:**… more