- State of Massachusetts (Westborough, MA)
- …at ### and select option #4. *Applicants should upload a_cover letter_and_resume_for the Nurse Reviewer requisition.* *First consideration will be given to those ... Services* **Organization:** **Exec Office Of Health and Human Services* **Title:** * Nurse Reviewer * **Location:** *Massachusetts-Westborough - 167 Lyman Street*… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day… more
- Beth Israel Lahey Health (Boston, MA)
- …Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on ... of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for… more
- Fallon Health (Worcester, MA)
- …appeal to the Plan Medical Director, Center for Medicare/Medicaid Services, contracted reviewer , and the Plan contracted external review agency in accordance ... and member expectations. Under the direction of the Director, the Appeal Nurse represents, manages and oversees second level appeal cases (Office of Medicaid,… more
- Beth Israel Lahey Health (Burlington, MA)
- …necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized case managers ... necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized case managers… 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 care setting, appropriateness and timeliness of treatments/procedures and to optimize the potential for reimbursement. + Collaborates with the multidisciplinary… more
- Beth Israel Lahey Health (Cambridge, MA)
- …**Primary Responsibilities** (including but not limited to): 1. Performs utilization review and discharge planning to inpatient admissions to MAH. 2. Applies ... of care criteria and reports them to the physician reviewer . 7. Works with patients and families to facilitate...Bachelor's degree preferred. Current state license as a Registered Nurse . 2. Three years of medical/surgical nursing care experience.… more
- Robert Half Accountemps (Boston, MA)
- …RNs to step into impactful non-clinical roles - including chart review , clinical auditing, utilization management, quality assurance, and case coordination. These ... or corporate healthcare roles. Requirements Featured Opportunity: RN Auditor / Clinical Reviewer + Work for a Fortune 500 healthcare organization + Audit medical… more
- Baystate Health (Springfield, MA)
- …Center (BMC), a Magnet Hospital for Nursing Excellence is looking for a** ** Nurse Educator** **to join our** **Cardiac Cath and Electrophysiology Lab!** **The ... Nurse Educator, utilizes innovative and flexible solutions** **_(including leveraging...advancement of clinical nursing practice and professional development through review , critique, and dissemination of relevant current literature, research… more
- State of Massachusetts (Boston, MA)
- …service provision, and effective internal quality reviews. Additionally, the ALR Unit Nurse will review and evaluate reports with potentially related clinical ... Office of Aging and Independence (AGE) is seeking a highly motivated*Registered Nurse *to join our Assisted Living Residence (ALR) Certification Unit. This role… more
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