- Elevance Health (Woburn, MA)
- ** Nurse Reviewer I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... rotating weekends.** **New Grads are encouraged to apply!** The ** Nurse Reviewer I** will be responsible for...that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or… 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
- Evolent (Boston, MA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks ... cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… more
- Children's Hospital Boston (Boston, MA)
- …Posting Title:Surgical Clinical Reviewer (20 hours/week)Department:Patient Services-Patient Care OperationsAutoReqId:82669BRStatus:Part-TimeStandard Hours per ... yours included. Position Summary / Department Summary The Surgical Clinical Reviewer collects, compiles, and submits reliable surgical data to the American… more
- Humana (Boston, MA)
- …and help us put health first** The Manager, Fraud and Waste Investigator: Nurse Audit/ Review performs clinical audit/validation processes to ensure that medical ... is complete, compliant and accurate to support optimal reimbursement. The Manager, Nurse Audit/ Review works within specific guidelines and procedures; applies… 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
- Veterans Affairs, Veterans Health Administration (Leeds, MA)
- …series. For more information, refer to Required Documents below. This Registered Nurse (Deputy Associate Director for Patient Care/Deputy Nurse Executive) ... is full-time at 40 hours per week. Responsibilities The Nurse IV Deputy ADPCS/Deputy Nurse Executive is...place to evaluate individual practice, as well as a review process for annual performance ratings. Partners with the… more
- Baystate Health (Greenfield, MA)
- …and implementing care for patients. **2)** For each assigned patient, the nurse will proficiently perform a comprehensive nursing assessment and use professional ... selective data to arrive at nursing diagnoses and discharge planning needs. The nurse will perform a systematic comprehensive assessment of the health needs of all… more
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