- Commonwealth Care Alliance (Springfield, MA)
- …complexities that require intensive care management and care delivery. Within the CIC Program, the Registered Nurse ( RN ) serves as an integral member of an ... and based on the fluctuating needs of the defined panel of members, the Registered Nurse will engage in regular assessments, visits at regularly scheduled… more
- Beth Israel Lahey Health (Cambridge, MA)
- …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 ... on the key performance indicators and quality measures, the RN specialist also aims to foster a culture of...reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts,… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances team ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
- Beth Israel Lahey Health (Plymouth, MA)
- …team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding ... job that may reasonably be required._ **Education/Experience Required:** + Current MA RN licensure + Bachelor's Degree in Nursing or advanced degree in healthcare… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA and other...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- Fallon Health (Worcester, MA)
- …or healthcare setting preferred. **License/Certifications:** Active, unrestricted license as a Registered Nurse In Massachusetts **Experience:** + A minimum of ... LinkedIn. **Brief Summary of Purpose:** The Manager, Prior Authorization RN manages all staffing and activities related to prior...three to five years' clinical experience as a Registered Nurse , in a clinical setting required.… more
- Children's Hospital Boston (Boston, MA)
- …or Utilization Management) preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse ( RN ) + A certification as a Certified ... 80451BRJob Posting Title:Per Diem RN Case Manager, Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard… more
- Tufts Medicine (Lowell, MA)
- …professionals, resolving difficult and sometimes complex problems. **Job Overview** The RN Case Manager manages a designated caseload to coordinate and complete ... transitions across the continuum of care. **Job Description** **Minimum Qualifications:** 1. Massachusetts RN Licensure. 2. 3 Years of RN Experience. 3. Current… more
- Tufts Medicine (Melrose, MA)
- …to work close to home with a community hospital. **Job Overview** The RN Case Manager manages a designated caseload to coordinate and complete timely assessment, ... Flexibility between 8am-4:30pm Rotating Weekends **Job Description** **Minimum Qualifications:** 1. Massachusetts RN Licensure. 2. 3 Years of RN Experience. 3.… more
- Prime Therapeutics (Boston, MA)
- …Patient Programs. **Education & Experience** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings and consults with...for work visa or residency sponsorship. **Additional Qualifications** + Registered Nurse ( RN ). + 5… more