- Baylor Scott & White Health (Boston, MA)
- …priority. Note: Benefits may vary based on position type and/or level **Job Summary** As the Utilization Review RN you will review patient cases for ... provider's care coordination departments. Your expertise is needed to review medical necessity. Working with the team, you'll verify...experience is required. + You must hold a valid Registered Nurse License ( RN ). As… more
- Children's Hospital Boston (Boston, MA)
- … Utilization Management) preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse ( RN ) + A certification as a Certified ... 80451BRJob Posting Title:Per Diem RN Case Manager, Utilization Management/ReviewDepartment:Patient Services-Patient Care… more
- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt **Position Summary:** The Sr Clinician, Behavioral Health Utilization Review will review behavioral health and substance use ... in behavioral health managed care preferred + Experience in behavioral health utilization review or medical necessity evaluation preferred **Required Knowledge,… more
- CVS Health (Boston, MA)
- …care **Preferred Qualifications** + NICU experience highly preferred + Managed care/ utilization review experience + Ability to multitask, prioritize and ... remote role open to candidates with an active RN licensure in the state in which they reside....to promote quality effectiveness of healthcare services and benefit utilization . **Required Qualifications** + Active and unrestricted RN… more
- Fallon Health (Worcester, MA)
- …tier of service at subacute facilities * Conduct concurrent and retrospective utilization review for inpatient, observation or SNF services * Recognizes, ... identifies, and implements appropriate opportunities to help meet Utilization goals * Knowledge of managed care, quality, and...of Massachusetts Board of Registration in Nursing as a Registered Nurse . Valid Driver's License CCM or… more
- Highmark Health (Boston, MA)
- …Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
- Molina Healthcare (Worcester, MA)
- …identifying opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational ... performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity,... Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of … more
- 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
- WTW (Boston, MA)
- …Third Party Administrator, Regulatory Agency, Legal/Compliance Firm, or insurance company + US Registered Nurse or LCSW with active licensed preferred + Health ... issues or impact to timeline proactively to Project Manager + Complete initial review of carrier responses for parity projects + Map carrier responses to appropriate… more
- Actalent (Boston, MA)
- …with all company policies and standards. Essential Skills + Proficiency in clinical review , case management, utilization review , and utilization ... Clinical Review Clinician Job Description As a Clinical ...Medicare, and Medicaid regulations is preferred. + Familiarity with utilization management processes is preferred. + State Licensure as… more
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