- Beth Israel Lahey Health (Boston, MA)
- …other related duties as required and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse ( RN ), Massachusetts + Three years of recent ... Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate...concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records… more
- Cognizant (Boston, MA)
- …expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
- Beth Israel Lahey Health (Plymouth, MA)
- …using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to ... the hospitalized patient. + Conducts concurrent reviews to determine the continued need for acute...may reasonably be required._ **Education/Experience Required:** + Current MA RN licensure + Bachelor's Degree in Nursing or advanced… more
- Beth Israel Lahey Health (Cambridge, MA)
- …reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, interpret ... Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported...to collect data for reporting quality measures, including both concurrent medical record review and periodic medical… more
- Fallon Health (Worcester, MA)
- …in nursing required** **License/Certifications** + Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience** + A minimum of three ... from medical care providers as needed for the clinical review process + Conducts pre-authorization and concurrent ...to five years clinical experience as a Registered Nurse in a clinical setting required.… more
- Beth Israel Lahey Health (Winchester, MA)
- …New England States for consideration** The Clinical Documentation Improvement (CDI) Specialist Registered Nurse ( RN ) assists with the appropriate ... of Morality (ROM), during an inpatient hospitalization. CDI Specialist RN initiates concurrent queries to providers as...assignment, risk of morality, and severity of illness. Track review details in 3M software. Conducts follow-up reviews of… more
- Cambridge Health Alliance (Somerville, MA)
- …Campus **Work Days:** Mon-Fri; 8:00-4:30, rotating weekends and holidays **Category:** Registered Nurse **Department:** Inpatient Case Management SH **Job ... RN Case Manager - Inpatient Case Management SH...**This position in onsite in Somerville** Department Description: Utilization review (UR) in behavioral health that evaluates the medical… more
- Beth Israel Lahey Health (Plymouth, MA)
- …the job that may reasonably be required._ **Education/Experience Required:** _Required_ + State of MA Registered Nurse ( RN ) + 3-5 years acute care nursing + ... cost, 4) reducing readmissions. **Duties/Responsibilities:** **A. Utilization Management** Performs review of anticipated admissions utilizing InterQual criteria to assess… more
- Baystate Health (Springfield, MA)
- …Diem Hospital Case Manager** The ** RN Hospital Case Manager** is a registered nurse responsible for the coordination of clinical care, quality, and financial ... and implements interventions for patients at risk for readmissions + Manages concurrent denials and works with physicians to overturn for appropriate reimbursement… more
- Fallon Health (Worcester, MA)
- …field preferred. **License/Certification** + License: Active, unrestricted license as a Registered Nurse in Massachusetts + Certification: Certification in Case ... the member to return to the community. + Conducts concurrent utilization review for members that are...**Experience** + 3+ years of clinical experience as a Registered Nurse managing chronically ill members or… more