6 registered nurse case manager jobs found

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. This role is full-time (40 hours per week) Monday through Friday with a Weekend Rotation shared among Staff. Coordinates patient care utilization and discharge planning by applying clinical criteria, collaborating with care teams, and ensuring appropriate levels of care. Supports patient transitions, compliance, quality improvement, and regulatory standards while maintaining strong communication, customer service, and participation in organizational activities. Job Description: Essential Duties & Responsibilities including but not limited to: 1) Performs utilization review and discharge planning to inpatient admissions. 2) Applies Interqual, AEP and or other review criteria approved by the Clinic to accurately determine appropriateness for inpatient and outpatient care. 3) Utilizes clinical expertise to determine the appropriate level of care for...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. This role is part-time, Saturday and Sunday, 10 Hour Days, working specifically with the Emergency Department. Coordinates patient care utilization and discharge planning by applying clinical criteria, collaborating with care teams, and ensuring appropriate levels of care. Supports patient transitions, compliance, quality improvement, and regulatory standards while maintaining strong communication, customer service, and participation in organizational activities. Job Description: Essential Duties & Responsibilities including but not limited to: 1) Performs utilization review and discharge planning to inpatient admissions. 2) Applies Interqual, AEP and or other review criteria approved by the Clinic to accurately determine appropriateness for inpatient and outpatient care. 3) Utilizes clinical expertise to determine the appropriate level of care for...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. This position is part time, 20 hours per week (2 10-hour shifts), and would predominantly support the Emergency Department at Lahey Clinic. Primarily weekday shifts, but some weekends may be required. Coordinates patient care utilization and discharge planning by applying clinical criteria, collaborating with care teams, and ensuring appropriate levels of care. Supports patient transitions, compliance, quality improvement, and regulatory standards while maintaining strong communication, customer service, and participation in organizational activities. Job Description: Essential Duties & Responsibilities including but not limited to: 1) Performs utilization review and discharge planning to inpatient admissions. 2) Applies Interqual, AEP and or other review criteria approved by the Clinic to accurately determine appropriateness for inpatient and...

Location : CHA Cambridge Hospital Work Days : Mon-Fri; 8:00-4:30, rotating weekends and holidays Category : Registered Nurse Department : Inpatient Case Management CH Job Type : Part time Work Shift : Day Hours/Week : 24.00 Union Name : MNA Cambridge Department Description: Inpatient Case Management provides psychosocial assessments, evaluations, and referrals for adults, and/or families with psychiatric illness, substance abuse, and medical illness. Casework or therapy takes place in the hospital setting. Cross Training to all areas of Care Management Summary: Under the general supervision of the Director of Care Management, the RN Case Manager provides clinically-based case management to support the delivery of effective and efficient patient care consistent with the Centers for Medicaid and Medicare Conditions of Participation. The RN Case Manager will collaborate with other members of the health care team to identify appropriate utilization of resources...

Location: CHA Everett Hospital Work Days: 8-4:30pm including weekend rotation Category: Registered Nurse Department: Inpatient Case Management Everett Job Type: Per Diem Work Shift: Day Hours/Week: 0.00 Union: Yes Union Name: MNA Everett DEPARTMENT DESCRIPTION: Inpatient Case Management provides psychosocial assessments, evaluations, and referrals for adults, and/or families with psychiatric illness, substance abuse, and medical illness. Casework or therapy takes place in the hospital setting. Cross Training to all areas of Care Management Under the general supervision of the Director of Care Management, the RN Case Manager provides clinically-based case management to support the delivery of effective and efficient patient care consistent with the Centers for Medicaid and Medicare Conditions of Participation. The RN Case Manager will collaborate with other members of the health care team to identify appropriate utilization of resources...

Reporting to the Manager of Prior Authorization, the Prior Authorization Supervisor is responsible for managing the operational workflows and staff obtaining drug and laboratory procedure prior authorizations from third-party payers. This work will primarily address on-/off-label drugs and molecular pathology procedures provided in the outpatient hospital setting. A key focus of the Prior Authorization Supervisor will be to apply appropriate medical knowledge to all functions of the prior authorization work. He/She will oversee and ensure staff applies appropriate medical knowledge and training. The Prior Authorization Supervisor will assist with prior authorization medical necessity inquiries, with a primary focus on drug and laboratory prior authorizations. Prior Authorization work requires its staff to serve as liaisons between the clinical team and third-party payers. The Prior Authorization Supervisor will demonstrate a strong ability to collaborate with these key...