- Beth Israel Lahey Health (Boston, MA)
- …people's lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...required and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse ( RN ), Massachusetts +… 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 ... Weekend and holiday rotations required **Job Description:** The Inpatient Registered Nurse ( RN ) Case Manager...Leads the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review… 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. +...work experience + Hold a valid registration as a Registered Nurse As a health care system… 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 ... and educate to improve outcomes. -Assists with preparation and presentation of utilization review monitoring/trending reports for review with physicians… more
- Cambridge Health Alliance (Cambridge, MA)
- …Center **Work Days:** Generally Mon-Fri days 8-4:30 and one evening/wk **Category:** Registered Nurse **Department:** Office Based Opioid Grant **Job Type:** ... OBOT RN Case Manager **Date Posted:** 01/16/2025 **Requisition Number:**...a business card. * Integrates the discharge planning/coordination and utilization review functions in the case management… 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) ... **_Tufts Medicine has a new Community RN Career Pathway plan_** that allows you to...customer satisfaction, while striving for optimal efficiency, productivity, and utilization of all resources. Provides patient and staff education,… 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 ... are currently hiring a Clinical Care Manager - OBAT RN based in Framingham. As part of a team-based...self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and… more
- Edward M. Kennedy Community Health Center, Inc. (Milford, MA)
- …may require evening, weekend and/or holiday shifts on a rotating basis. Job Requirements: + Registered Nurse License in MA + 1-2 years of clinical experience + ... engagement in self-care, decreasing risk status, and minimizing hospital and ER utilization . + Identifies, manages, and coordinates patient care and provides ongoing… more
- Baystate Health (Springfield, MA)
- **Hospital Case Manager** Per Diem The Hospital Case Manager is a registered nurse responsible for the coordination of clinical care, quality, and financial ... and Competencies:** + Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by third party payers… more
- Beth Israel Lahey Health (Cambridge, MA)
- …annually. c. Maintains BLS, ACLS certification d. Attends Emergency Department RN Competency Review Course annually. e. Attends hospital-based Education ... 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… 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 ... expectations, continuing education, credentialing, performance appraisals, auditing, concurrent monitoring, utilization review , risk management and active problem… 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 ... regulations. The role will also be responsible for timely review and research, as necessary on all new and...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- Highmark Health (Providence, RI)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management, and… more
- Veterans Affairs, Veterans Health Administration (Providence, RI)
- …full-time at 40 hours per week. The Nurse Interventional Radiology (IR) Registered Nurse ( RN ) is responsible for providing competent, evidence-based care ... VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities This RN...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Guardian Life (Providence, RI)
- **Position Summary** The RN Clinical Consultant serves as a clinical resource for the investigation and assessment of medical information regarding disability by ... medical reviews and analysis of long-term disability claims. The RN Clinical Consultant identifies restrictions, limitations and duration impacting functional… more
- University of Connecticut (UConn) (Storrs, CT)
- …- Mental Health (MH), is seeking applicants for a Psychiatric Advanced Practice Registered Nurse (APRN) for the position of Director, Psychiatric Medication ... mental health and wellness concerns for student populations. The Advanced Practice Registered Nurse maintains an independent clinical practice, performing acts… more
- Baystate Health (Palmer, MA)
- …Bachelor of Science (Required) **Certifications:** Case Management Certification - Other, Registered Nurse - State of Massachusetts **Equal Employment ... and documents findings of the Interdisciplinary Care Plan. Collaborates with the Utilization Management Coordinator and other members of the healthcare team to… more
- Beth Israel Lahey Health (Cambridge, MA)
- …for the overall operation of care transitions discharge planning and/or utilization management departments through oversight of daily and long-term activities at ... **Job Description:** **PLANNING:** Plans department's clinical services and operations including review of tracking and trending data to assess need for performance… more
- Beth Israel Lahey Health (Burlington, MA)
- …to the age of the patient Cares for patients as delegated by the provider, RN or LPN within scope of practice and competence. Contributes information provided by the ... plans since last appointment were followed and results are available for physician review Confirms that lab and other ancillary tests are performed and results… more
- Beth Israel Lahey Health (Burlington, MA)
- …to the age of the patient Cares for patients as delegated by the provider, RN or LPN within scope of practice and competence. Contributes information provided by the ... plans since last appointment were followed and results are available for physician review + Confirms that lab and other ancillary tests are performed and results… more