Job Description: Utilization Review RN Lead II - BPM Who We Are: UST HealthProof is a trusted partner... all, equitably and effectively. You Are: UST HealthProof is searching for a highly motivated Utilization Review RN...
Job Description: Medical Review and Appeals RN Lead II - BPM Who We Are: UST HealthProof is a trusted partner... experience which may include acute patient care, discharge planning, case management, and utilization review...
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...
for understanding Review the entire medical record for accuracy, and appropriate clinical treatment Communicate findings of audits... of disease pathology to review chart/clinical information, ask appropriate questions, and identify appropriate course of care...
for understanding Review the entire medical record for accuracy, and appropriate clinical treatment Communicate findings of audits... of disease pathology to review chart/clinical information, ask appropriate questions, and identify appropriate course of care...
, outpatient coding, utilization review, CDI or other disciplines with either coding experience however, an equivalent combination..., the Pre-Visit Clinical Review Specialist (CRS) facilitates the accurate and appropriate identification of patient medical...
to be part of Mass General Brigham. Shift: 40HR VARIABLE ROTATING Job Summary GENERAL SUMMARY OVERVIEW STATEMENT RN CARE... COORDINATOR (CASE MANAGER) BWH CARE CONTINUUM The RN Care Coordinator (RNCC) manages a caseload of patients and is responsible...
increased volume and to support the overall care management process and the department. Are you a collaborative RN who thrives... navigate the healthcare system with efficiency, compassion, and clinical expertise. Position: RN Care Manager Department...
POSITION SUMMARY: The RN Endoscopy Navigator is a vital member of the care team, ensuring timely, safe, and patient... education tailored to their needs. Acting as a bridge between patients, families, and healthcare providers, the RN Endoscopy...
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...
capacity by maintaining regular communication with HOT. Review and oversee all admissions to ensure that all necessary referral... adherence to the Medication Administration Program (MAP) in partnership with the Shelter RN, including oversight of staff...
(TTT) assessment - Experience in utilization review or utilization management Home Office Requirements - Maximus... for managing all aspects of contract expectations which include: financial review, client management and effective delivery...
Description : The Utilization Review Case Manager gathers demographic and clinical information on prospective... regarding certification or denial of treatment Documents all work in the appropriate manner Promotes utilization review...
issues and conduct quality improvement research utilization projects. Ability to effectively delegate appropriate patient... climate and personnel issues. Cardiology experience preferred, position requires review of telemetry monitoring system...
, Claims, Utilization Management, Pharmacy) to ensure the timely resolution of all appeals and grievances. Meet regularly... and analysis to various internal stakeholders including, but not limited to, the Quality Improvement Committee, the Utilization...
, 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...
, utilization review, and discharge planning experience. 11/18/2025...; current RN license in Massachusetts; CPR Certified; a minimum of three years as a Registered Nurse in pediatrics, women...