Top 822 Nurse case managers Jobs in Boston, Ma

Medical Director
WellSense Health Plan —Boston, MA
- $173,000 - $250,000 a year
- Full-time
- Background check
- Medicine
- Office
- Health insurance
- Dental insurance
Registered Nurse (RN) - Admissions
Caring Bees Healthcare —Boston, MA
- $95,000 - $100,000 a year
- Full-time
- Background check
- CPR Certification
- RN License
- Health insurance
- Dental insurance
Quick Apply
Hospice Admissions Nurse
All Care —Somerville, MA
- $105,300 - $113,100 a year
- Full-time
- RN License
- Mid-level
- Driver's License
- 403(b) matching
- Mileage reimbursement
Quick Apply
14d
SCO Assessment Nurse Case Manager - Lawrence/Lowell
Fallon Health —Lawrence, MA
- $95,000 - $100,000 a year
- Full-time
- Nursing
- RN License
- Mid-level
Registered Nurse (RN)
Brighton Hospice —Boston, MA
- $96,000 - $106,000 a year
- Skilled nursing facility
- RN License
- Nursing home
- Health insurance
- Dental insurance
Registered Nurse- Genetics
Boston Children's Hospital —Brookline, MA
- $81,078 - $174,585 a year
- 8 hour shift
- Nursing
- RN License
- Mid-level
- Health insurance
- Dental insurance
NURSE CASE MANAGER (WEST REGION)
Intellia Therapeutics —Cambridge, MA
- $193,500 - $236,500 a year
- Weekends as needed
- Remote
- Nursing
- RN License
- HIPAA
- Free parking
- Commuter assistance
Nurse Case Manager (West Region)
Intellia —Cambridge, MA
- $193,500 - $236,500 a year
- Weekends as needed
- Remote
- Nursing
- RN License
- HIPAA
RN Case Manager
Blue Cross Blue Shield of Massachusetts —Hingham, MA
- $44.12 - $53.93 an hour
- Full-time
- Remote
- RN License
- Mid-level
- 3 years
- Health insurance
- Dental insurance
Clinical Documentation Specialist II- RN- Remote
Beth Israel Lahey Health —Charlestown, MA
- $102,000 - $158,392 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
Prior Authorization Supervisor
Dana-Farber Cancer Institute —Brookline, MA
- $96,500 - $109,100 a year
- Full-time
- Nursing
- RN License
- Writing skills
Behavioral Health Nurse Navigator
South Shore Health —Weymouth, MA
- $93,000 - $175,000 a year
- Full-time
- Acute care
- Nursing
- RN License
Care Coordinator, PSP HUB
Praxis Precision Medicines, Inc. —Boston, MA
- $86,000 - $106,000 a year
- Email
- Remote
- 5 years
- Mid-level
- Bachelor's degree
- AD&D insurance
- Employee stock purchase plan
Quick Apply
Senior Consultant - Clinical Documentation Specialist
Deloitte —Boston, MA
- $110,700 - $218,300 a year
- Full-time
- Microsoft Word
- Nursing
- RN License
Hybrid Registered Nurse Clinical Care Manager
CareSource —Boston, MA
- $80,000 - $120,000 a year
- Weekends as needed
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Wellness program
- Mileage reimbursement
Community Healthcare Worker-Bowdoin Street
Beth Israel Lahey Health —Boston, MA
- $28.50 - $38.36 an hour
- Full-time
- Spanish
- Microsoft Excel
- Microsoft Outlook
Registered Nurse – HCA Primary Care (Full Time)
Beth Israel Lahey Health —Boston, MA
- $38.00 - $98.19 an hour
- Full-time
- Nursing
- RN License
- Hospital
Nurse Case Manager- Per diem, Day
Beth Israel Lahey Health —Milton, MA
- $37.08 - $92.84 an hour
- Call employer
- Nursing
- RN License
- Hospital
Clinical Documentation Improvement Specialist
Beth Israel Lahey Health —Charlestown, MA
- $102,000 - $158,392 a year
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
Field Case Manager
Sedgwick —Boston, MA
- Full-time
- Nursing
- RN License
- Mid-level
- Continuing education credits
- Health insurance

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Medical Director

WellSense Health Plan -
Boston, MA

Apply Now

Job Details

Full-time
$173,000 - $250,000 a year

Benefits

Health insurance
Dental insurance
Flexible spending account
Paid time off
Vision insurance
403(b)
Opportunities for advancement

Qualifications

Managed care organization experience
Medical License

Full Job Description

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Medical Director will report to the Senior Medical Director of Utilization Management, Member Appeals & Grievances, and Medical Policy (Senior Medical Director of Utilization Management) and support the staff of the Office of Clinical Affairs in the areas of medical management daily medical necessity reviews, evaluation of medical policy, utilization trend management, quality, appeals and grievances, and pharmacy reviews.

Our Investment in You:

Full-time remote work

Competitive salaries

Excellent benefits

Key Functions/Responsibilities:

Provides clinical case review, consultation and oversight for all utilization management activities in a fashion that is compliant with all federal, state, and NCQA requirements

Conducts review of prior authorizations, concurrent reviews and retrospective medical necessity reviews that do not meet standard criteria and determines coverage

Works with the Senior Medical Director of Utilization Management to identify appropriate use of InterQual criteria and Medical Policy

Works with the Senior Medical Director to ensure consistent medical decision making for all physician reviewers, including the contracted physicians

Conducts clinical review of appeals and grievances in a fashion that is compliant with all federal, state and NCQA requirements

Develops and supports clinical initiatives to support department quality improvement and utilization management goals

Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment

Collaborates with hospital physicians, medical directors, primary care physicians and nurse case managers in daily activities and initiatives to improve the health of the population, the quality and experience of care our members receive, and lower the overall cost of care at the population level

Participates in and chairs clinical committees as assigned by the Senior Medical Director of Utilization Management

Supports quality, and pharmacy committees and activities

Provides input to the strategic planning process for the Office of Clinical Affairs as requested

Represents the Chief Medical Officer or Senior Medical Directors in Massachusetts, New Hampshire and other locations as requested

Supervision Exercised:

Indirect technical direction is provided to the organization

Supervision Received:

General direction is received weekly

Qualifications:

Education:

Graduate as a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) from an accredited allopathic or osteopathic medical school

Experience:

8-10+ years of related experience is required including a minimum of 5 years direct clinical experience and a minimum of 3 years experience in medical management in a managed care setting

Preferred/Desirable:

Preference for those with Board Certification in the following:

Internal Medicine

Internal Medicine-Pediatrics (Med Peds)

Family Medicine

Emergency Medicine

Certification or Conditions of Employment:

Pre-employment background check

Active or lifetime board certification in recognized medical specialty of the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)

Current unrestricted licensure as an MD or DO in Massachusetts and New Hampshire is required, or ability to obtain in a reasonable timeframe

Current unrestricted licensure as an MD in Massachusetts or New Hampshire is preferred

No restriction on participation in Medicare or Medicaid programs

Competencies, Skills, and Attributes:

Excellent demonstrated clinical skills and knowledge

Excellent written and verbal communication skills.

Comprehensive knowledge of accrediting organizations such as NCQA.

Comprehensive knowledge of InterQual protocols, HEDIS, and other quality measures.

Knowledge of Medicare and state Medicaid regulations, guidelines, and standards.

Proven leadership skills and relationship building.

Knowledge of managed care principles and processes.

Ability to work independently with intermittent supervision.

Adhere to appropriate turn-around-times and deadlines while maintain results of high quality and reliability.

Working Conditions and Physical Effort:

Work is normally performed in a typical remote interior/office work environment

No or very limited physical effort required. No or very limited exposure to physical risk

Ability to travel to locations within New Hampshire and Massachusetts

Regular and reliable attendance is an essential function of the position

Compensation Range

$173,000 - $250,000

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note: This range is based on Boston-area data, and is subject to modification based on geographic location.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

Apply Now

Refine Your Search

nurse case managers jobs in boston, ma

Medical Director

Registered Nurse (RN) - Admissions

Hospice Admissions Nurse

SCO Assessment Nurse Case Manager - Lawrence/Lowell

Registered Nurse (RN)

Registered Nurse- Genetics

NURSE CASE MANAGER (WEST REGION)

Nurse Case Manager (West Region)

RN Case Manager

Clinical Documentation Specialist II- RN- Remote

Prior Authorization Supervisor

Behavioral Health Nurse Navigator

Care Coordinator, PSP HUB

Senior Consultant - Clinical Documentation Specialist

Hybrid Registered Nurse Clinical Care Manager

Community Healthcare Worker-Bowdoin Street

Registered Nurse – HCA Primary Care (Full Time)

Nurse Case Manager- Per diem, Day

Clinical Documentation Improvement Specialist

Field Case Manager

I want to receive the latest job alert for nurse case managers in boston, ma

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