- US Tech Solutions (Canton, MA)
- …all aspects of clinical decision making and support needed to perform utilization management , medical necessity determinations and benefit determinations using ... criteria through participation in the IMPAC. Proactively identifies trends in Utilization Management applicable to the precertification and outpatient UM… more
- Healthcare Staffing Plus (Boston, MA)
- The registered nurse , adheres to the rules and regulations of the Massachusetts Board of Registration in Nursing. is primarily responsible for professional ... patients and their families across the health care continuum. The registered nurse is accountable for clinical, educational, quality and fiscal patient care outcomes… more
- UMass Memorial Health (Worcester, MA)
- …data. 3. Excellent organizational and communications skills required. Preferred: 1. Utilization management and third-party payer knowledge preferred. Unless ... if the RN has successfully completed the Framingham State College Graduate Certificate Nurse Case Management program. 2. The ability to effectively use… more
- The Elmhurst Healthcare (Melrose, MA)
- …from the RN as necessary At the direction of the RN, participates in utilization management or interdisciplinary care management meeting to facilitate ... RN, Nursing Supervisor, Unit Manager, DON and/or ADON, the licensed practical nurse delivers efficient and effective nursing care while achieving positive clinical… more
- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- CVS Health (Boston, MA)
- …care **Preferred Qualifications** + NICU experience highly preferred + Managed care/ utilization review experience + Ability to multitask, prioritize and ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in… more
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible ... reports to the Director of Utilization Management * Oversees clinical decision review for...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- US Tech Solutions (Canton, MA)
- …all aspects of clinical decision making and support needed to perform utilization management , medical necessity determinations and benefit determinations using ... criteria through participation in the IMPAC. + Proactively identifies trends in Utilization Management applicable to the precertification and outpatient UM… more
- Beth Israel Lahey Health (Burlington, MA)
- …you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered ... the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg… more
- Children's Hospital Boston (Boston, MA)
- …Posting Title:Per Diem RN Case Manager, Utilization Management /ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard ... + Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current Massachusetts license… more
