• Manager - Utilization Review…

    Beth Israel Lahey Health (Plymouth, MA)
    …trends/root causes of denials for discussion with the internal team, physician advisor and the Utilization Review Committee as appropriate. + Participate ... you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We Are:** At… more
    Beth Israel Lahey Health (10/30/25)
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  • RN System Director Utilization Management…

    Tufts Medicine (Burlington, MA)
    …coordinates the design, development, implementation, and monitoring of the organization's utilization review functions. The position establishes the department's ... the utilization of resources, coordination of care across the continuum and utilization review and management. The position develops and leads the … more
    Tufts Medicine (10/31/25)
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  • Registered Nurse - Utilization…

    Beth Israel Lahey Health (Plymouth, MA)
    …management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established guidelines ... using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to… more
    Beth Israel Lahey Health (10/30/25)
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  • Director Case Management

    Brockton Hospital (Brockton, MA)
    …, denials, appeals and reconsideration hearings. Works closely with the physician advisor to proactively intervene in cases where utilization of resources is ... delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare… more
    Brockton Hospital (09/12/25)
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  • ED RN Case Manager - UR & Discharge Planning

    Beth Israel Lahey Health (Plymouth, MA)
    …and reimbursement. Refers inappropriate observation or anticipated admission cases to the Physician Advisor . Provides real time interventions to prevent delays ... 3) Decreasing unit cost, 4) reducing readmissions. **Duties/Responsibilities:** **A. Utilization Management** Performs review of anticipated admissions utilizing… more
    Beth Israel Lahey Health (10/30/25)
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  • Dialysis Clinical Manager Registered Nurse - RN

    Fresenius Medical Center (Fairhaven, MA)
    …departments and external customers; particularly in problem resolution. Acts as an advisor to subordinate(s) to meet schedules and/or resolve technical problems. + ... staff in problem solving. **PHYSICIANS:** + Facilitates the application process for physician privileges and compliance with FMS Medical Staff By-Laws. + Responsible… more
    Fresenius Medical Center (10/29/25)
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