- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) ... timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring… more
- Beth Israel Lahey Health (Plymouth, MA)
- …the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- CVS Health (MA)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Humana (Boston, MA)
- …**Use your skills to make an impact** **Required Qualifications** + An active, unrestricted Registered Nurse (RN) license in the state of Michigan. + Previous ... of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management Leader) utilizes clinical… more
- Fresenius Medical Center (Lowell, MA)
- …supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve ... of maximum quality care to all patients. + Must complete Clinical Manager training modules and ongoing developmental programs within the specified time line.… more
- Commonwealth Care Alliance (Boston, 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
- Brockton Hospital (Brockton, MA)
- …lives and health of our patients. Position Summary: Purpose of Position : The Registered Nurse provides nursing care to assigned patients newborn to geriatric ... independently within established department policies and goals . Refers problems to nurse manager or appropriate supervisor . Supervisory Responsibilities :… more
- Baystate Health (Springfield, MA)
- …Center (BMC), a Magnet Hospital for Nursing Excellence is looking for a New Graduate Registered Nurse to join our team in Springfield, MA. At Baystate Health, RN ... **Certifications:** Basic Life Support - American Heart AssociationAmerican Heart Association, Registered Nurse - State of MassachusettsState of Massachusetts… more
- Baystate Health (Springfield, MA)
- …(BMC), a Magnet Hospital for Nursing Excellence is looking for a medical inpatient Registered Nurse to join our team in Springfield, MA. At Baystate Health, ... **Certifications:** Basic Life Support - American Heart AssociationAmerican Heart Association, Registered Nurse - State of MassachusettsState of Massachusetts… more
- Beth Israel Lahey Health (Cambridge, MA)
- …to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by leading the ... reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts,...If you're unable to resolve a situation, find a manager who can. **9. Protect confidentiality and privacy:** It's… more