• RN System Director…

    Tufts Medicine (Burlington, MA)
    …**Minimum Qualifications:** 1. Bachelor of Science in Nursing (BSN). 2.Massachusetts RN Licensure. 3. Current certification in case/ utilization management (ACM, ... MA. **About Tufts Medicine:** Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver… more
    Tufts Medicine (09/11/25)
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  • Utilization Review Medical Director

    Commonwealth Care Alliance (Boston, MA)
    023520 Clin Alli-Physicians Group **Position Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review, the Utilization ... will be responsible for providing leadership and subject matter expertise to our utilization management (UM) group. This role is a key role in helping our… more
    Commonwealth Care Alliance (09/05/25)
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  • Medical Policy Director

    Commonwealth Care Alliance (Boston, MA)
    011200 CCA-Central Clin Ops Leadership **Position Summary:** Reporting to the Sr. Medical Director of Utilization Management (UM) and Policy, the Medical Policy ... to the population serviced by CCA. The Medical Policy Director is an independent contributor who works in partnership...workflows are streamlined and maintained + Develop and maintain systems for tracking medical policy reviews and revisions. +… more
    Commonwealth Care Alliance (08/31/25)
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  • Quality & Patient Safety Specialist…

    Beth Israel Lahey Health (Cambridge, MA)
    …just taking a job, you're making a difference in people's lives.** Reporting to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse ... on the key performance indicators and quality measures, the RN specialist also aims to foster a culture of...reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts,… more
    Beth Israel Lahey Health (08/08/25)
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  • RN Clinical Manager

    CenterWell (Pittsfield, MA)
    …+ Graduate of an accredited School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's license, auto insurance ... analysis to determine efficiency, the efficacy of case management system as well as any other systems ...and reliable transportation. + Two years as a Registered Nurse with at least one-year of… more
    CenterWell (08/16/25)
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  • After Hours Pediatric Triage RN…

    Atrius Health (Boston, MA)
    …delivery market. *SUMMARY * Under the direction of the Clinical Director , Nurse Leader or designee, the professional licensed registered nurse provides ... its partnership with Optum, a leading national value-based care system , Atrius Health continues its longitudinal growth in the...the primary care, and limited specialty service lines. The RN utilizes the nursing process and adheres to current… more
    Atrius Health (08/29/25)
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  • Director Clinical Documentation Integrity

    Tufts Medicine (Burlington, MA)
    …technology. **Job Description** **Minimum Qualifications:** 1. BSN degree 2. Licensed as a Registered Nurse 3. Five (5) years relevant experience in the ... impact key performance indicators (KPI) for the department and the health care system . The Director assists in leading continuous improvement in the development… more
    Tufts Medicine (07/04/25)
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  • Care Transitions RN Case Manager

    Beth Israel Lahey Health (Boston, MA)
    …you're not just taking a job, you're making a difference in people's lives.** The RN Case Manager working in the Triad Model of Care Transitions partners with the ... the hospitalized patient. Together with the medical provider, the RN Case Manager collaborates with all members of the...of efficient, high-quality care. This position ensures the appropriate utilization of clinical resources with a goal of a… more
    Beth Israel Lahey Health (09/10/25)
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  • Appeals and Grievances Clinical Specialist…

    Healthfirst (MA)
    …as Microsoft Word and Excel, as well as corporate email and virtual filing system , (ie. Macess). Experience with care management systems , such as CCMS, TruCare ... quality for each Specialist against expectations + Prepare cases for Medical Director Review ensuring that all pertinent information (ie case summary, contract… more
    Healthfirst (09/09/25)
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  • RN -Clinical Manager Hospice House

    Tufts Medicine (Haverhill, MA)
    …**Minimum Qualifications:** 1. Bachelor's degree in Nursing (BSN). 2. Massachusetts RN Licensure. 3. Five (5) years of palliative, hospice, complex care ... the palliative care and hospice programs, ie Medical Directors, hospital personnel, vendors, director , managers and staff to ensure optimal care. + Ensures staff are… more
    Tufts Medicine (09/09/25)
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