- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- ERP International (San Diego, CA)
- **Overview** ERP International is seeking a full-time ** Registered Nurse ( RN ) Health Educator** supporting **Naval Medical Center San Diego, CA ... of other individuals performing similar services. ? Participate in peer review and performance improvement activities. ? Practice aseptic techniques as necessary.… more
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... Knowledge, Skills & Abilities (must have): - Expertise in managing utilization review processes including prior authorization, concurrent and retrospective… more
- Stanford Health Care (Palo Alto, CA)
- …America) **A Brief Overview** The Oncology Research Nursing Professional (ORNP) -is a Registered Nurse ( RN ) who works collaboratively with Clinical Research ... If you're ready to be part of our legacy of hope and innovation,...in a related field **Licenses and Certifications** + California Registered Nurse ( RN ) + American… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- … RN Appeals Coordinator.** This role collaborates with clinical review staff, medical directors/physician reviewers, network physicians, and network facilities to ... Friday; 8:00 AM -5:00 PM CST (Flexible) **Responsibilities** A. Performs necessary review to ensure compliance with HHSC and other regulatory entities + Collaborate:… more
- Stanford Health Care (Palo Alto, CA)
- …their APPs. Also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), or ... If you're ready to be part of our legacy of hope and innovation,...practice provider: (Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or Certified Registered Nurse… more
- Stanford Health Care (Palo Alto, CA)
- …affect the processes and outcomes of patient health care **Licenses and Certifications** + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact ... If you're ready to be part of our legacy of hope and innovation,...include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review … more
- Commonwealth Care Alliance (Boston, MA)
- …success. + Conduct regular provider meetings (virtual and in-person) to review performance, discuss program updates, and address operational challenges. + Represent ... Lead the monitoring and analysis of provider performance using utilization , quality, and member experience metrics. + Collaborate with...self-motivated, with the ability to work independently and as part of a team to meet departmental goals. +… more
- Commonwealth Care Alliance (Boston, MA)
- …understanding of CCA's mission, value-based approach, and expectations for quality, utilization , and member experience. - Address provider inquiries related to care ... coordination, utilization management, and program participation, collaborating with internal teams...BH and Health Home providers. - Participate in case review meetings and rounds as needed to enhance coordination… more
- Commonwealth Care Alliance (Springfield, MA)
- …medical and behavioral health patients. The SBHC functions within and is an integral part of a highly skilled interprofessional team model. The SBHC ensures that a ... influence the clinical outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment for behavioral health needs, and closing quality… more
