- Beth Israel Lahey Health (Boston, MA)
- …lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...required and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse (RN), Massachusetts + Three years… 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 ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- Commonwealth Care Alliance (Springfield, MA)
- …that require intensive care management and care delivery. Within the CIC Program, the Registered Nurse (RN) serves as an integral member of an interdisciplinary ... and based on the fluctuating needs of the defined panel of members, the Registered Nurse will engage in regular assessments, visits at regularly scheduled… more
- Beth Israel Lahey Health (Cambridge, MA)
- …reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, interpret ... Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported...for reporting quality measures, including both concurrent medical record review and periodic medical record review for… more
- 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
- Humana (Boston, MA)
- …timeframe **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) Compact license, with no disciplinary action + 3 ... caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes...Complete medical record reviews + Assess discharge plans + Review and extract information from claims + Complete documentation… more
- Evolent (Boston, MA)
- …Required and Preferred:** + Current, unrestricted state licensure as a Registered Nurse - **Required** + **California or Oregon License Required** ... , you will be a key member of the utilization management team. We can offer you a meaningful...+ Associate or Bachelors in Nursing (Must be a Registered Nurse ) - **Required** + You must… more
- Evolent (Boston, MA)
- …are applied appropriately. **Qualifications:** + Current, unrestricted state licensure as a Registered Nurse + Associate or Bachelors in Nursing (Must be ... , you will be a key member of the utilization management team. We can offer you a meaningful...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not...a Registered Nurse ) + Experience as an RN… more
- Beth Israel Lahey Health (Cambridge, MA)
- …Description:** **Primary Responsibilities** (including but not limited to): 1. Performs utilization review and discharge planning to inpatient admissions to ... **Required Qualifications:** 1. Bachelor's degree preferred. Current state license as a Registered Nurse . 2. Three years of medical/surgical nursing care… more
- 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
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