• Registered Nurse…

    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 ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
    Beth Israel Lahey Health (05/17/25)
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  • Case Manager Utilization Review…

    Beth Israel Lahey Health (Burlington, MA)
    …people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse (RN) Case Manager for ... Clinic inpatient admissions. Leads the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case… more
    Beth Israel Lahey Health (05/11/25)
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  • Per Diem RN Case Manager, Utilization…

    Children's Hospital Boston (Boston, MA)
    …Utilization Management) preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse (RN) + A certification as a Certified Case ... 80451BRJob Posting Title:Per Diem RN Case Manager, Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard Hours per Week:1… more
    Children's Hospital Boston (06/16/25)
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  • Manager Utilization Management

    Beth Israel Lahey Health (Burlington, MA)
    …collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities ... Duties & Responsibilities** _including but not limited to:_ + Ensures that Utilization Review nurses are consistently recommending the appropriate admission… more
    Beth Israel Lahey Health (06/06/25)
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  • Registered Nurse , ED Resource RN-…

    Tufts Medicine (Lowell, MA)
    …Hospital is seeking an **ED Clinical Resource Nurse .** The ED Clinical Resource Nurse is a Registered Nurse with responsibility and accountability for ... productivity and utilization of all resources. The ED Clinical Resource Nurse utilizes the nursing process, leadership skills and current evidence based clinical… more
    Tufts Medicine (06/25/25)
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  • Dialysis Program Manager Registered…

    Fresenius Medical Center (Northampton, MA)
    …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
    Fresenius Medical Center (06/21/25)
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  • Clinical Appeals Nurse Reviewer

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    … Units to assist with medical necessity determinations. Key Qualifications: + Registered Nurse with an active unrestricted professional Massachusetts Nursing ... customers, relaying decisions accurately and thoroughly. Education and Experience: + Registered Nurse with an active Massachusetts Nursing license required… more
    Blue Cross Blue Shield of Massachusetts (06/26/25)
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  • Perinatal Safety Nurse

    Baystate Health (Springfield, MA)
    …Degree in Nursing (Required) **Certifications:** EFM or Inpatient Obstetrics - NCC, Registered Nurse - State of Massachusetts **Equal Employment Opportunity ... **Summary:** The Perinatal Safety Nurse is a member of Obstetric Nursing Leadership...nursing/provider leadership, Performance Improvement Coordinator, and Risk Management. Additionally, review adverse events and be a member of OB… more
    Baystate Health (07/08/25)
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  • RN, ACO Nurse Care Manager, Community…

    Baystate Health (Springfield, MA)
    …- American Heart AssociationAmerican Heart Association, Driver License - OtherOther, Registered Nurse - State of MassachusettsState of Massachusetts **Equal ... **RN, ACO Nurse Care Manager, Community Health Center** The **ACO...room, or from a skilled nursing facility. Responsible to review the discharge summaries, follow up on testing that… more
    Baystate Health (07/14/25)
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  • Disease Management Nurse - Remote

    Sharecare (Boston, MA)
    …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
    Sharecare (07/12/25)
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