sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical... to be part of Mass General Brigham. Staff Nurse - 40hr Variable Day - BWH Utilization Management Job Summary The Insurance...
sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical... to be part of Mass General Brigham. Staff Nurse - 40hr Variable Day - BWH Utilization Management Job Summary The Insurance...
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...
, 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...
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. This is a part-time role, 28 hrs...
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...
- Proficiency in Smartsheet - Familiarity with the Time to Test (TTT) assessment - Experience in utilization review...Description & Requirements Maximus is hiring for the Senior Clinical Program Manager (Registered Nurse) for the...
(TTT) assessment - Experience in utilization review or utilization management Home Office Requirements - Maximus...Maximus is hiring for the Senior Clinical Program Manager (Registered Nurse) for the MA EOHHS Program which provides...
POSITION SUMMARY: The registered nurse, adheres to the rules and regulations of the Massachusetts Board... across the health care continuum. The registered nurse is accountable for clinical, educational, quality and fiscal patient care...
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...
, 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...
, 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...
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...
for all utilization management activities in a fashion that is compliant with all federal, state, and NCQA requirements ·Conducts review... Director will report to the Senior Medical Director of Utilization Management, Member Appeals & Grievances, and Medical Policy...
, and problem-solving skills Case Management Certification (CCM) preferred or obtained within 24 months Knowledge of utilization... review, discharge planning, managed care, and community resources Why You’ll Love Working Here You’ll be part...
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...