- 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 ... patients to ensure the right LOC. It involves ensuring compliance with clinical guidelines, and determining whether the services...patient care consistent with the Centers for Medicaid and Medicare Conditions of Participation. The RN Case… more
- Commonwealth Care Alliance (Springfield, MA)
- …as NP or PA in primary care or care management AND 3+ years' experience as Registered Nurse or EMT-P in a high touch clinical environment or home care; OR ... and referrals to LTSS providers + Medication Reconciliation + Proactive and routine well-visits and preventative care + Evaluate...or PA graduate, must have 5+ years' experience as Registered Nurse or EMT-P in a high… more
- Commonwealth Care Alliance (Boston, MA)
- …enhance the risk adjustment data ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment programs. + Represent ... in SQL, data integration, and systems development are essential. Knowledge of Medicare risk adjustment methodologies is highly desirable. The ideal candidate is a… more
- Commonwealth Care Alliance (Boston, MA)
- …direct supervision for the Clinical Support Coordinators (CSCs) to ensure proactive administrative clinical team support and accurate, prompt, and courteous service ... staff provide quality patient care and service delivery through proactive work and by responding to inquiries immediately and...to meet team needs. * Adhere to all applicable compliance requirements and the Code of Conduct. * Provides… more
- Baystate Health (Springfield, MA)
- …for leading the hospital's enterprise-wide strategies in **patient safety** and **regulatory compliance ** . Reporting to the **Chief Medical Officer (CMO)** , this ... The VP oversees incident management, risk mitigation, policy development, and proactive strategies to reduce harm while supporting the hospital's mission of… more
- Tufts Medicine (Lowell, MA)
- …**Minimum Qualifications** **:** 1. Bachelor's degree in Nursing (BSN). 2. Massachusetts RN Licensure. 3. Three (3) years of experience in community hospice clinical ... on clinical, patient satisfaction and operational issues. 16. Reports Compliance concerns to the CEO or Chief Compliance...player with management staff to handle problems in a proactive manner and maintains a positive and supportive attitude… more
- CenterWell (Boston, MA)
- …**Use your skills to make an impact** **Required Qualifications** + Licensed Registered Compact Nurse license ( RN ) with no disciplinary ... and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent...a related field + Health Plan experience + Previous Medicare /Medicaid Experience a plus + Call center or triage… more