years of utilization review experience is highly preferred Experience using Interqual or Milliman is highly preferred..., and render approval decisions, to determine the need for physician review as well as complete determinations following physician...
of experience. Manages a department of utilization review professionals usually consisting of Registered Nurses, Social Workers...+ years of Utilization Review experience 2+ years management experience Preferred Skills: Master’s Degree Nursing...
POSITION SUMMARY: The Nurse Manager for Utilization Review and Clinical Appeal Management is responsible... with hospital policies, regulatory requirements, and payer guidelines while supporting efficient and effective utilization review...
Nursing preferred Massachusetts Registered Nurse License required At least 2-3 years of utilization review experience..., and render approval decisions, to determine the need for physician review as well as complete determinations following physician...
of case management, utilization review, or discharge planning experience required Community care experience... necessary authorization for reimbursement of services. -Review cases with medical directors on challenging cases...
, grievances, utilization review, or related healthcare services required At least 2-3 years of clinical experience... means to be part of Mass General Brigham. Job Summary The role is an integral part of our Appeals and Grievance review...
and/or ADON, the licensed practical nurse delivers efficient and effective nursing care while achieving positive clinical outcomes... and patient family satisfaction. The LPN operates within the scope of practice defined by the state nurse practice act. The LPN...
and/or utilization review. Experience with InterQual® or similar clinical review tools. BSN and CCM/CPUM certification preferred...Case Management Registered Nurse (RN) – Travel Location: Hyannis, MA 02601 Duration: 13 Weeks Shift: Day | 5×8s...
and/or ADON, the licensed practical nurse delivers efficient and effective nursing care while achieving positive clinical outcomes... and patient family satisfaction. The LPN operates within the scope of practice defined by the state nurse practice act. The LPN...
Case Manager (CM) performs utilization reviews and coordinates discharge planning for MAH inpatient admissions. Inpatient... Qualifications: 1. Bachelor’s degree preferred. 2. Current Massachusetts state license as a Registered Nurse (RN). 3. Two years...
Department of Public Health (MDPH) including the utilization of the MAVEN surveillance database. Responsible for communicable... and Epidemiologist team to assist with outbreak investigations. In coordination with other Public Health Nurse division staff, provide...
responsible for facilitating admissions, clinical intake assessments, and utilization review processes to assure continuity... for the most appropriate level of care for patients and their benefit/resource utilization. Responsibilities REGISTERED...
, utilization review, and discharge planning experience. 11/18/2025... base pay only and does not include any other benefits or compensation. Registered Nurse, Care Coordinator...
, and real-time support for caregivers. Our clinical programs are designed to improve quality, reduce avoidable utilization... & operational staff, there is a career here for you. Join our team today! Job Summary: Position Title: Nurse Practitioner – House...
to discharge are met. 6. Incorporates knowledge of utilization management principles and payer contracts into patient plans... and nurse learning needs related to case management and works with service leaders to develop educational plan. B. Discharge...
and expanding utilization across key existing and emerging accounts. This role proactively identifies and develops high-value... physician, nurse, and technologist training and account in-servicing of dialysis access products. Provide product technical...
. 4. Experience in drug utilization review and analysis. 5. Experience with Electronic Medical Records. Duties... or otherwise actively participate in a hospital multidisciplinary committee. 19. Contacts physician or nurse when necessary...
Utilization Review, Performance Improvement, Risk Assessment, Infection Surveillance, and the coordination of discharge planning... and not all inclusive): Oversee case coordination, utilization review, discharge planning, and resource allocation across assigned units...
job description and in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review. POSITION...The UM RN will be responsible for review of potential transfers to the BMC System for tertiary care, in conjunction...
in the attached job description and in the Utilization Review Plan in accordance with the CMS Conditions of Participation... for Utilization Review. Position: Case Manager (on site) Department: Denials and Appeals Schedule: 30 Hours (Weekends) Weekend...