- US Tech Solutions (Canton, MA)
- …but required** **unrestricted MA license** **Overview:** We are seeking an experienced ** Utilization Review Nurse ** to provide clinically appropriate and ... effectively through their continuum of care. **Key Responsibilities:** + Perform utilization management activities, applying criteria such as InterQual, MCG, and… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in ... Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality assurance for Lahey… more
- 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 ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse (RN), Massachusetts + Three years of recent clinical… more
- Humana (Providence, RI)
- …a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Baylor Scott & White Health (Providence, RI)
- …vary based on position type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff. You oversee care coordination across ... Factors** + Demonstrable knowledge in discharge planning, case management, utilization review and different care levels. +...experience + Hold a valid registration as a Registered Nurse As a health care system committed to improving… more
- Hartford HealthCare (Mansfield Center, CT)
- …empowering individuals to participate in their own care and recovery. _*Job Summary*_ Utilization Review Care Manager coordinates the care of clients in ... your moment.* **Job:** **Behavioral Health* **Organization:** **Natchaug Hospital* **Title:** * Utilization Review Care Manager - Behavioral Health* **Location:**… 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
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- Summary The Registered Nurse -CLC Minimum Data Set position is located in Quality and Patient Safety service at the Bedford campus. This position is full time 40 ... hours per week.. Responsibilities VA offers a comprehensive total rewards package: VA Nurse Total Rewards The Community Living Center (CLC) Minimum Data Set (MDS)… 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...authorizing practice in an expanded role as a Psychiatric Nurse Clinical Specialist and authorization including prescriptive authority. _In… more
- Beth Israel Lahey Health (Cambridge, MA)
- …with Harvard Medical School. The Inpatient Case Manager (CM) performs utilization reviews and coordinates discharge planning for MAH inpatient admissions. Inpatient ... (including but not limited to): 1. Using established clinical criteria, the Nurse Case Manager identifies and communicates to the team opportunities for providing… more
- Edward M. Kennedy Community Health Center, Inc. (Milford, MA)
- …engagement in self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and provides ongoing ... point-of-care testing, treatments, and lab and diagnostic test result review + Documents patient care, ongoing evaluation, patient progress/risk status,… more
- Edward M. Kennedy Community Health Center, Inc. (Framingham, MA)
- …engagement in self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and provides ongoing ... point-of-care testing, treatments, and lab and diagnostic test result review + Provides timely and informed patient triage +...shifts on a rotating basis. Required Qualifications: + Registered Nurse License in MA + Bachelor's degree in Nursing… more
- Tufts Medicine (Lowell, MA)
- …and customer satisfaction, while striving for optimal efficiency, productivity, and utilization of all resources. Provides patient and staff education, clinical ... participates in unit-based activities (quality assessment, shared governance, quality review , staff development in-services, simulation drills, etc.) **Job Description**… more
- Fresenius Medical Center (Medford, MA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Sharecare (Providence, RI)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for early ... participate in the orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required for all Sharecare… more
- Veterans Affairs, Veterans Health Administration (Providence, RI)
- …not limited to: Receives and manages a community specialty care assignment. Provides utilization management and utilization review services. Provides care ... and licensure/certification. Preferred Experience: Outpatient care management/clinical care coordination Utilization review Utilization management Grade… more
- Evolent (Providence, RI)
- …be the single point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work can be divided into ... for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for utilization … more
- Evolent (Providence, RI)
- …a mission with a company behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part of ... focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and procedures… more
- Highmark Health (Providence, RI)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to assure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management, and… more
- University of Connecticut (UConn) (Storrs, CT)
- …Health (MH), is seeking applicants for a Psychiatric Advanced Practice Registered Nurse (APRN) for the position of Director, Psychiatric Medication (Services Student ... and wellness concerns for student populations. The Advanced Practice Registered Nurse maintains an independent clinical practice, performing acts of diagnoses and… more