Nursing Jobs in Sutton, MA

CNA Full-time
Stillwater Assisted Living and Skilled Nursing Community

Certified Nursing Assistant 11p to 7a

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
Assisted Living in beautiful setting seeking CNA's to care for our residents We are looking for skilled CNAs (Certified Nursing Assistants) to join our facility's compassionate care-giving team. We are currently hiring full-time 11p-7a candidates. The CNA will interact directly with residents, providing comfort and care, monitoring their vital signs and assisting with daily living needs. We are searching for dedicated, compassionate and energetic individuals to be a vital link between our patients and the nurses and other facility staff. Salary is commensurate with experience. Tasks: Assist with daily living activities. This includes delivering meals to patients, turning and ambulating patients Help patients with personal hygiene. Provide residents with bathing, shampoos and showers Check vital signs and record daily information in the patient's chart Assist the nurses and other staff as needed Adhere to professional standards, follow policies and procedures and abide by federal, state and local requirements, as well as Joint Commission standards Skills and Requirements: High School diploma or GED Completion of a state-approved CNA certification training course Basic computer skills Ability to work as part of a team and to handle multiple tasks safely and effectively Good communication skills, including the ability to communicate sensitive information with empathy ("bedside manner") High tolerance for working under pressure and handling critical situations with a cool head Job Types: Full-time, Part-time
CNA Part-time
Stillwater Assisted Living and Skilled Nursing Community

Certified Nursing Assistant

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
We are looking for a skilled CNA (Certified Nursing Assistant) to become a part of our facility's compassionate care-giving team in our Assisted Living community. We have part-time positions availabe for 7-3pm and 11p-7am which includes every other weekend The CNA will interact directly with fesidents, providing comfort and care, monitoring their vital signs and assisting with daily living needs. We are searching for dedicated, compassionate and energetic individuals to be a vital link between our residents and the nurses and other facility staff. Competitive rates and benefit package. Facility also offers flexible scheduling options.
CNA Part-time
Stillwater Assisted Living and Skilled Nursing Community

Certified Nursing Assistant

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
We are looking for a skilled CNA (Certified Nursing Assistant) to become a part of our facility's compassionate care-giving team in our Assisted Living community. We have part-time positions availabe for 7-3pm and 11p-7am which includes every other weekend The CNA will interact directly with fesidents, providing comfort and care, monitoring their vital signs and assisting with daily living needs. We are searching for dedicated, compassionate and energetic individuals to be a vital link between our residents and the nurses and other facility staff. Competitive rates and benefit package. Facility also offers flexible scheduling options.
CNA Part-time
Stillwater Assisted Living and Skilled Nursing Community

Certified Nursing Assistant

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
We are looking for a skilled CNA (Certified Nursing Assistant) to become a part of our facility's compassionate care-giving team in our Assisted Living community. We have part-time positions availabe for 7-3pm and 11p-7am which includes every other weekend The CNA will interact directly with fesidents, providing comfort and care, monitoring their vital signs and assisting with daily living needs. We are searching for dedicated, compassionate and energetic individuals to be a vital link between our residents and the nurses and other facility staff. Competitive rates and benefit package. Facility also offers flexible scheduling options.
CNA Part-time
Stillwater Assisted Living and Skilled Nursing Community

Certified Nursing Assistant

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
We are looking for a skilled CNA (Certified Nursing Assistant) to become a part of our facility's compassionate care-giving team in our Assisted Living community. We have part-time positions availabe for 7-3pm and 11p-7am which includes every other weekend The CNA will interact directly with fesidents, providing comfort and care, monitoring their vital signs and assisting with daily living needs. We are searching for dedicated, compassionate and energetic individuals to be a vital link between our residents and the nurses and other facility staff. Competitive rates and benefit package. Facility also offers flexible scheduling options.
CNA Part-time
Stillwater Assisted Living and Skilled Nursing Community

Certified Nursing Assistant

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
We are looking for a skilled CNA (Certified Nursing Assistant) to become a part of our facility's compassionate care-giving team in our Assisted Living community. We have part-time positions availabe for 7-3pm and 11p-7am which includes every other weekend The CNA will interact directly with fesidents, providing comfort and care, monitoring their vital signs and assisting with daily living needs. We are searching for dedicated, compassionate and energetic individuals to be a vital link between our residents and the nurses and other facility staff. Competitive rates and benefit package. Facility also offers flexible scheduling options.
CNA Part-time
Stillwater Assisted Living and Skilled Nursing Community

Certified Nursing Assistant

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
We are looking for a skilled CNA (Certified Nursing Assistant) to become a part of our facility's compassionate care-giving team in our Assisted Living community. We have part-time positions availabe for 7-3pm and 11p-7am which includes every other weekend The CNA will interact directly with fesidents, providing comfort and care, monitoring their vital signs and assisting with daily living needs. We are searching for dedicated, compassionate and energetic individuals to be a vital link between our residents and the nurses and other facility staff. Competitive rates and benefit package. Facility also offers flexible scheduling options.
CNA Part-time
Stillwater Assisted Living and Skilled Nursing Community

Certified Nursing Assistant

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
We are looking for a skilled CNA (Certified Nursing Assistant) to become a part of our facility's compassionate care-giving team in our Assisted Living community. We have part-time positions availabe for 7-3pm and 11p-7am which includes every other weekend The CNA will interact directly with fesidents, providing comfort and care, monitoring their vital signs and assisting with daily living needs. We are searching for dedicated, compassionate and energetic individuals to be a vital link between our residents and the nurses and other facility staff. Competitive rates and benefit package. Facility also offers flexible scheduling options.
LPN Part-time
Stillwater Assisted Living and Skilled Nursing Community

LPN

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
Seeking LPN to be a part of our team in our beautiful Assisted Living community. Part-time and per diem positions available, flexible hours. The LPN will be an essential support person in our nursing department assisting with the daily management of the residents’ nursing needs and oversight of direct care staff. Must be able to multi-task, have a team oriented focus and experience providing care to individuals with dementia and their families. EEOC. Job Type: Full-time or Part-Time Requirements: Valid LPN license in RI CPR Certified Healthcare: 1 year (Preferred) Long-Term care:and/or assisted living care experience 1 year (Preferred) Benefits offered: Paid time off Health insurance Dental insurance Other types of insurance Retirement benefits or accounts
LPN Part-time
Stillwater Assisted Living and Skilled Nursing Community

LPN

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
Seeking LPN to be a part of our team in our beautiful Assisted Living community. Part-time and per diem positions available, flexible hours. The LPN will be an essential support person in our nursing department assisting with the daily management of the residents’ nursing needs and oversight of direct care staff. Must be able to multi-task, have a team oriented focus and experience providing care to individuals with dementia and their families. EEOC. Job Type: Full-time or Part-Time Requirements: Valid LPN license in RI CPR Certified Healthcare: 1 year (Preferred) Long-Term care:and/or assisted living care experience 1 year (Preferred) Benefits offered: Paid time off Health insurance Dental insurance Other types of insurance Retirement benefits or accounts
LPN Part-time
Stillwater Assisted Living and Skilled Nursing Community

LPN

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
Seeking LPN to be a part of our team in our beautiful Assisted Living community. Part-time and per diem positions available, flexible hours. The LPN will be an essential support person in our nursing department assisting with the daily management of the residents’ nursing needs and oversight of direct care staff. Must be able to multi-task, have a team oriented focus and experience providing care to individuals with dementia and their families. EEOC. Job Type: Full-time or Part-Time Requirements: Valid LPN license in RI CPR Certified Healthcare: 1 year (Preferred) Long-Term care:and/or assisted living care experience 1 year (Preferred) Benefits offered: Paid time off Health insurance Dental insurance Other types of insurance Retirement benefits or accounts
LPN Part-time
Stillwater Assisted Living and Skilled Nursing Community

LPN

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
Seeking LPN to be a part of our team in our beautiful Assisted Living community. Part-time and per diem positions available, flexible hours. The LPN will be an essential support person in our nursing department assisting with the daily management of the residents’ nursing needs and oversight of direct care staff. Must be able to multi-task, have a team oriented focus and experience providing care to individuals with dementia and their families. EEOC. Job Type: Full-time or Part-Time Requirements: Valid LPN license in RI CPR Certified Healthcare: 1 year (Preferred) Long-Term care:and/or assisted living care experience 1 year (Preferred) Benefits offered: Paid time off Health insurance Dental insurance Other types of insurance Retirement benefits or accounts
LPN Part-time
Stillwater Assisted Living and Skilled Nursing Community

LPN

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
Seeking LPN to be a part of our team in our beautiful Assisted Living community. Part-time and per diem positions available, flexible hours. The LPN will be an essential support person in our nursing department assisting with the daily management of the residents’ nursing needs and oversight of direct care staff. Must be able to multi-task, have a team oriented focus and experience providing care to individuals with dementia and their families. EEOC. Job Type: Full-time or Part-Time Requirements: Valid LPN license in RI CPR Certified Healthcare: 1 year (Preferred) Long-Term care:and/or assisted living care experience 1 year (Preferred) Benefits offered: Paid time off Health insurance Dental insurance Other types of insurance Retirement benefits or accounts
LPN Part-time
Stillwater Assisted Living and Skilled Nursing Community

LPN

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
Seeking LPN to be a part of our team in our beautiful Assisted Living community. Part-time and per diem positions available, flexible hours. The LPN will be an essential support person in our nursing department assisting with the daily management of the residents’ nursing needs and oversight of direct care staff. Must be able to multi-task, have a team oriented focus and experience providing care to individuals with dementia and their families. EEOC. Job Type: Full-time or Part-Time Requirements: Valid LPN license in RI CPR Certified Healthcare: 1 year (Preferred) Long-Term care:and/or assisted living care experience 1 year (Preferred) Benefits offered: Paid time off Health insurance Dental insurance Other types of insurance Retirement benefits or accounts
LPN Part-time
Stillwater Assisted Living and Skilled Nursing Community

LPN

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
Seeking LPN to be a part of our team in our beautiful Assisted Living community. Part-time and per diem positions available, flexible hours. The LPN will be an essential support person in our nursing department assisting with the daily management of the residents’ nursing needs and oversight of direct care staff. Must be able to multi-task, have a team oriented focus and experience providing care to individuals with dementia and their families. EEOC. Job Type: Full-time or Part-Time Requirements: Valid LPN license in RI CPR Certified Healthcare: 1 year (Preferred) Long-Term care:and/or assisted living care experience 1 year (Preferred) Benefits offered: Paid time off Health insurance Dental insurance Other types of insurance Retirement benefits or accounts
Caregiver Full-time
Atria

Caregiver

Atria Hopedale, MA
Responsibilities What you will do as a Caregiver Enhance the lives of older adults by assisting them with mobility needs and daily living activities, including housekeeping, bathing, grooming, and routine personal tasks Work cooperatively with other talented team members to support and care for residents Receive on-the-job training and have opportunities for career growth and advancement Solve problems and exhibit ethical behavior Qualifications No experience needed. We will provide you with all the training you need! Apply today to join the Atria team. Atria is an equal opportunity employer committed to providing equal employment opportunities without regard to race, color, religion, sex (including pregnancy), sexual orientation, age, national origin, disability, genetic information, veteran status, or any other classification protected by applicable law.
RN Full-time
Stillwater Assisted Living and Skilled Nursing Community

Registered Nurse

Stillwater Assisted Living and Skilled Nursing Community RI
Stillwaer Assisted Living and Skilled Nursing Community is seeking a Registered Nurse to join our clinical team! Positions available on all shifts. facility offers competative rates and benefits package as well as flexible scheduling options.
LPN Part-time
Stillwater Assisted Living and Skilled Nursing Community

LPN

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
Seeking LPN to be a part of our team in our beautiful Assisted Living community. Part-time and per diem positions available, flexible hours. The LPN will be an essential support person in our nursing department assisting with the daily management of the residents’ nursing needs and oversight of direct care staff. Must be able to multi-task, have a team oriented focus and experience providing care to individuals with dementia and their families. EEOC. Job Type: Full-time or Part-Time Requirements: Valid LPN license in RI CPR Certified Healthcare: 1 year (Preferred) Long-Term care:and/or assisted living care experience 1 year (Preferred) Benefits offered: Paid time off Health insurance Dental insurance Other types of insurance Retirement benefits or accounts
CNA Part-time
Stillwater Assisted Living and Skilled Nursing Community

Certified Nursing Assistant

Stillwater Assisted Living and Skilled Nursing Community Smithfield, RI
We are looking for a skilled CNA (Certified Nursing Assistant) to become a part of our facility's compassionate care-giving team in our Assisted Living community. We have part-time positions availabe for 7-3pm and 11p-7am which includes every other weekend The CNA will interact directly with fesidents, providing comfort and care, monitoring their vital signs and assisting with daily living needs. We are searching for dedicated, compassionate and energetic individuals to be a vital link between our residents and the nurses and other facility staff. Competitive rates and benefit package. Facility also offers flexible scheduling options.
RN Other
Advocates

Registered Nurse

Advocates Framingham, MA
$42 / hour
Overview Hourly rate $42.00/hour The Registered Nurse (RN) participates in the coordination of medical, behavioral health/addiction treatment services and other supports in accordance with the person-centered treatment plan to manage or co-manage complex behavioral health cases. As a member of the multidisciplinary team, the RN provides consultation, education, and support to team members and provider network regarding co-occurring medical issues related to behavioral health/substance abuse treatment and management. Minimum Education Required Bachelor's Degree Additional Shift Details 1 hour a week for consulting Responsibilities Support consortium entity teams by providing supervision, conducting audits, and actively participating as a member of their team to ensure high-quality care coordination and compliance with best practices. Provide medical consultation to team members in the assigned consortium entity Liaison to and consult with the BHPMW BHCP Medical Director. Conduct medication reconciliation functions required in the BHCP Model Contract. Participate in BHCP team meetings to ensure effective communication among all disciplines. Participate in all required orientation and training and assist with training other staff on the Care Partner (CP) Team. Develop knowledge about all focus populations and assist CP Team members in doing so. Complete all required documentation in a timely manner. Demonstrate a proactive commitment to maintaining effective communication with staff, Enrollees, Care Team members and other collaterals, and other internal and external stakeholders and customers. Promote strong working relationships and excellent customer service. Complete required trainings and other professional development activities. Strictly adhere to HIPPA and confidentiality policies at all time, including when responding to inquiries for Enrollee information Attend and actively participate in supervision and staff meetings. Maintain current certifications and licenses Ensure that all clients are treated with dignity and respect Perform all duties in accordance with the agency’s policies and procedures. Strictly follow all agency Performance Standards. Qualifications Bachelor's Degree Registered Nurse licensed in the Commonwealth of Massachusetts with minimum of 4 years of experience working with adults in a community-based mental health, substance use and/or physical health setting Demonstrated knowledge base and judgment necessary for independent clinical decision making. Excellent verbal and written communications skills. Strong interpersonal and customer relations skills required. Excellent organizational, time management and problem solving skills. Strong computer knowledge, including proficiency in contemporary Windows operating systems and Windows office suites with an emphasis on Word and Excel; ability to learn new systems; experience entering and working with data; and comfort and experience using mobile technologies. Knowledge regarding psychiatric rehab and understanding of recovery model. Strongly prefer that a candidate will have a demonstrated understanding of and competence in serving culturally diverse populations. Must be able to perform each essential duty satisfactorily. Must hold a valid drivers’ license. Must have access to an operational and insured vehicle and be willing to use it to transport members. Must have ability to read English and communicate effectively in the primary language of the program to which he/she is assigned.
RN ER Part-time
UMass Memorial Health

Registered Nurse, Emergency Room, 24hr. 7p-7a

UMass Memorial Health Southbridge, MA
Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health? CLICK HERE to apply through your Workday account. Exemption Status: Non-Exempt Hiring Range: $34.39 - $61.91 Please note that the final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations . Schedule Details: Holidays - Every Other Holiday, Weekends - Every Third Weekend Scheduled Hours: 7p-7a Shift: 3 - Night Shift, 12 Hours (United States of America) Hours: 24 Cost Center: 25082 - 2340 Emergency Room This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process. Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day. Responsible for the planning, delivery and management of direct patient care utilizing the nursing process and adhering to the standards of nursing practice. I. Major Responsibilities: 1. Utilizes the Nursing Process for the delivery and management of patient’s care from Admission to Discharge, appropriate to the developmental age of the patient population. 2. Performs patient assessment/reassessment according to standard procedure. 3. Develops and coordinates individual plan of care including discharge planning. 4. Directs, supervises, coordinates and evaluate nursing care within assigned clinical setting. 5. Delegates appropriately to others in accordance with job description and competency level. 6. Documents patient care according to standard procedure. 7. Develops, implements/coordinates and documents Education Plan for patient/family/ significant other. 8. Ensures quality and continuity of care through collaboration with other health care providers. 9. Administers medications, performs treatments, therapies and operates equipment according to policy and procedure. Assists physician with treatment and procedures and special tests as required or directed. 10. Participates in and supports Nursing Governance activities. 11. Assumes responsibility for professional growth. Assists in education and development of staff. 12. Participates in performance improvement initiatives and demonstrate the use of quality improvement in daily operations. Standard Staffing Level Responsibilities: 1. Complies with established departmental policies, procedures and objectives. 2. Attends variety of meetings, conferences, seminars as required or directed. 3. Demonstrates use of Quality Improvement in daily operations. 4. Complies with all health and safety regulations and requirements. 5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors. 6. Maintains, regular, reliable, and predictable attendance. 7. Performs other similar and related duties as required or directed. All responsibilities are essential job functions. II. Position Qualifications: License/Certification/Education: Required: 1. Current Massachusetts licensure and registration. 2. Completion of an accredited school of nursing program. 3. BLS is a requirement for every RN unless advance cardiac life support (ACLS) certification is current, in addition to any unit specific certifications and competencies. Experience/Skills: Required: 1. Thorough knowledge of the discipline of Nursing. Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements. Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents. III. Physical Demands and Environmental Conditions: Work is considered medium. Position requires work indoors in a normal patient care environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day. As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law. If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.
LPN Manager/Supervisor Full-time
Benchmark Senior Living

LPN - Care Nurse Supervisor

Benchmark Senior Living Framingham, MA
The Branches of Framingham, a Benchmark Assisted Living & Memory Care community is hiring Full Time or Part Time & Per Diem Nurses. Available Shifts: Monday 2pm-10pm Wednesday 2pm-10pm Friday 7am-3pm, 2pm-11pm (or opportunity to work a double) Every Other Weekend required Excellent Benefits RN's welcome to apply Join, stay, and grow with Benchmark. Connect with your calling. We are looking for a compassionate Licensed Practical Nurse (LPN) to join our team! As a Licensed Practical Nurse, your main role will be to deliver nursing care to our residents within a warm, comfortable, and home-like environment. You will be part of a team of dedicated, like-minded individuals whose support and camaraderie build community, and where long-lasting relationships with both associates and residents await. If you possess a dedication to assisting others, take immense pride in your work, and are looking for a remarkable company that aligns with those values, then this opportunity is made for you! Responsibilities Accurately assesses, communicates, and documents residents’ status. Observes and reports any significant changes in resident behavior and health to the Resident Care Director, physician, family, RCAs, and Executive Director per state regulations. Directs and supervises the daily work assignments of the Resident Care Assistants. Closely mentors, guides, and directs the Lead Resident Care Assistants in all aspects of their job. Coordinates care needs with community providers via an effective case management process. Effectively balances service demands with supporting resident independence. Recognizes and assists in the prevention of elder abuse, neglect, and exploitation (financial and other) and reports to appropriate sources per state regulations. Responds to emergencies and personal emergency response system and knows when to call for backup. Requirements Current state license as an LPN and CPR certification Graduate of an approved LPN program (per state requirements) Minimum of 1 to 2 years of experience working as a nurse preferred Previous experience working with the elderly in a paid or volunteer position is highly desirable As a community associate at Benchmark, you will have access to a variety of benefits including, but not limited to, the following: 8 holidays & 3 floating holidays Discounted Meal Program Paid Training & Company-provided Uniforms Associate Referral Bonus Program Physical & Mental Health Wellness Programs 401k Retirement Plan with Company Match* Medical, Vision & Dental Benefits* Tuition Reimbursement Program* Vacation and Health & Wellness Paid Time Off* *Eligibility may vary by employment status
RN Director of Nursing Utilization Review Other
Fallon Health

RN Director, Utilization Management & Prior Authorization - Hybrid

Fallon Health Worcester, MA
Overview About us: Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn. Brief summary of purpose: With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief Medical Officer will provide strategic leadership and oversight responsibility for the clinical and operational utilization management activities for all inpatient and outpatient care, and staff across all product lines. Responsibilities Utilization Management: Oversees all administrative, operational and clinical functions related to outpatient and inpatient, utilization management operations, including but not limited to prior authorization, concurrent review and discharge planning. Ensures that members get the appropriate care that is medically necessary and meets the benefit coverage criteria. Ensures that all reviews meet the appropriate regulatory and accreditation requirements including turnaround times and communication. Ensures program compliance with all federal regulatory and state mandates, Division of Insurance, National Committee for Quality Assurance standards, Centers for Medicare and Medicaid guidance and requirements, MassHealth (Medicaid contractual agreements). Responsible for hiring appropriate non-physician clinical and non-clinical personnel to review medical cases and determine if requests for services meet medical necessities and criteria for coverage. Oversight of UM by delegated organizations and ensure regulatory and accreditation compliance, Monitors and analysis of operational and outcome data related to all utilization management activities. Recommends and implements innovative process improvements for the prior authorization and utilization management processes Develops and implements the Utilization Management Program Description and annually evaluate the effectiveness of the program. Represents the UM Department in Program Audits across all LOBs, including information gathering, research, presenting, and development of Corrective Action Plans (if applicable) Key Contact for RFP responses related to UM Functions and department organization structure/staffing. Works with VP/Medical Director to identify and prioritize the cost of care opportunities related to Utilization Management. Works with VP/ Medical Director to set agenda related to UM and represent the plan at clinical joint operating committees to support collaborative Fallon/provider group relationship. Manages data, predictive analytics to improve efficiency of prior authorization and utilization management Works with and represents Care Services for utilization management on the different product line task forces at Fallon. Serves as SME and Point of Contact for internal committees including but not limited to Delegation Oversight Committee (DOC), Payment Policy, Mental Health Parity, Medical Directors monthly meeting, and TruCare Insights/upgrade meetings. Represents the Vice President and Senior Medical Director of Clinical Management at internal and external senior level meetings. Budget creation and management of annual budget. Clinical Integration Support: Provides UM expertise to Clinical Integration leadership to ensure seamless integrated member care within Care Services as well as other departments by involving inpatient case management with out-patient case management and utilization management to optimize post-acute care. Manage and develop staff: Ensures objectives defined across a broader group are integrated and supportive where necessary. Defines roles and accountabilities for staff, within the group and in the context of the broader process/operation in support of cross-functional efforts. Hires for, develops and recognizes the experience and knowledge/skills/abilities required for a successful team. Provides for the orientation and welcome of new staff. Defines performance expectations and goals for staff. Trains and mentors’ staff on the application of policy and procedures, use of supporting systems/applications, appropriate soft skills: time management, etc. Monitors work of individual staff for efficiency, effectiveness and quality. Provide ongoing constructive feedback and guidance to staff. Evaluates staff on achievement of goals and deliverables and assessment of competencies. Helps staff progress in their careers to the benefit of the department and broader organization. Manages the resolution of performance issues in consultation with Human Resources as appropriate. Qualifications Education: Master’s degree in health administration or business preferred. Bachelor’s degree in nursing or related health field required. License/Certifications: Massachusetts Nursing Licensure Experience: Broad experience in managed care and /or integrated delivery systems, either payer or provider. Significant experience in regulatory and accreditation compliance requirements for Medicare, Medicaid and the division of insurance support all Fallon Health Products Experience in managing health care and support personnel, as well as managing health care personnel and external relationships. A comprehensive knowledge of utilization management strategies to manage utilization and costs. Minimum of ten years clinical experience, at least five in managed care or ambulatory clinical operations. Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $155,000 - 175,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities. Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. #P01
RN Other
Fallon Health

Temporary to Hire Prior Authorization RN - Hybrid Remote

Fallon Health Worcester, MA
Overview This is 3 months temporary contract position for a Prior Authorization RN. About us: Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn. Brief summary of purpose: The PA Nurse uses a multidisciplinary approach to review service requests (prior-authorizations), focusing on selected complex medical and psychosocial needs of FH members and their families. The PA Nurse is responsible for assuring the receipt of high quality, cost efficient medical outcomes for enrollees. This role works with Medical Directors, Authorization Coordinators, and Service Coordinators to perform pre-service, concurrent, and retrospective reviews for outpatient services such as elective procedures, home health care, DME, nutrition, and genetic testing utilizing established state, federal, and internally developed benefit and clinical coverage criteria against FH polices and protocols. Medical necessity determinations are reviewed with the holistic picture of the member in mind, which requires exceptional attention to detail, proficiency in applying correct criteria, and collaboration with internal and external partners. Responsibilities Primary Job Responsibilities: • Obtain clinical, functional, and psychosocial information from the medical records on site, through remote electronic access, telephonically or by fax in a collaborative effort with other health care professionals, member and/or family• Refers cases to medical review according to policy and procedure• Documents clinical, functional, psychosocial information in the Core System as well as communications regarding the members’ care• Keeps records and submits reports as assigned by the Manager• Refers high-risk cases to the appropriate FH internal teams (ie: Outpatient Case Management, NaviCare, ACO) and/or other community services according to department protocol• Collaborates with attending physicians and health care professionals regarding appropriate utilization of medical services• Completes level of care/service request reviews strictly adhering to regulatory turnaround time guidelines such as, but not limited to, CMS, NCQA, and the DOI• Identifies utilization issues unique to their team assignment and identifies strategies to address/resolve these issues• Issues regulatory and other letters according to the department policies and procedures. • Electronic copies of all denial letters and related documents are kept in the Fallon Health core application and/or the organization’s security accessed drive(s)• Acts as a liaison between Providers, vendors, facilities, members/families, and Fallon Health internal departments. Clarifies policies/procedures and member benefits as needed. Authorizes services, coordinates care, and ensures timeliness and coordination of healthcare services, in compliance with department and regulatory standards, seeking supplemental services when appropriate or when needed• Works with Fallon Health providers/support staff and/or members to facilitate cost-effective, quality care• Requests and obtains relevant clinical information from medical care providers as needed for the clinical review process• Conducts pre-authorization and concurrent clinical reviews requests for services such as DME, elective procedures, Home Health Care, Out of network specialty care, transportation and genetics, against appropriate criteria/guidelines to determine medical necessity, benefit eligibility, and network contract status • Refers all cases that do not meet medical necessity, benefit eligibility, and network contract status criteria to a physician reviewer for consideration, ensuring the timely review of the referred case• Incrementally monitors the effectiveness of established plans of care with defined, measurable goals and objectives and cost-benefit documentation as applicable and modifies the care plan when applicable.• Streamlines the focus of the member’s healthcare needs utilizing the most optimal treatment approach, promoting timely provision of care, enhancing quality of life, and promoting cost-effectiveness of care.• Analyzes and applies CMS always INPT and SDS CPT codes during PA clinical reviews when a surgical procedure is requested as IP LOC• Collaborates with Fallon Health departments to ensure services/items needed to facilitate discharge from a post-acute or hospital setting do not delay discharge• Collaborate with external providers on alternative coverage options when services requested do not meet medical necessity, benefit eligibility, and network contract status criteria• Creates contingency plans for each step of the process to anticipate treatment and service complications, while ensuring that the member attains pre-determined outcomes• Reviews physician reviewers’ determinations for appropriateness and completeness • Communicates determinations to providers and members telephonically and in writing, adhering to corporate/department Communicates determinations to providers and members telephonically and in writing,adhering to corporate/department policy and regulatory guidelines• Will check voicemail at regular intervals throughout the day and returns calls/messages within the same day of receipt• Strictly observes the Fallon Health policies regarding confidentiality of member information, documentation standards, meeting any education requirements, and performs other responsibilities as assigned by department management team• Participates in weekly medical rounds with the leadership team, Medical Directors, and various Fallon Health departments to discuss patient issues and/or concerns. Organizes and presents complex medical cases in a clear and concise oral and written manner• Ensures ad hoc contracts are in place for non-contracted services working in conjunction with FH Network Development team Qualifications Education Graduate from an accredited school of nursing, Associate’s Degree, Bachelors Degree, or advanced degree in nursing required License/Certifications: Active and unrestricted licensure as a Registered Nurse in Massachusetts. Experience: • A minimum of three to five years clinical experience as a Registered Nurse in a clinical setting required. • 2 years’ experience as a Utilization Management/Prior Authorization nurse in a managed care payer preferred.• One year experience as a case manager in a payer or facility setting highly preferred.• Relevant experience may include but not be limited to experience working directly in the field of Home Health Care, Ambulatory Provider Setting, Rehabilitation Nursing Setting, Acute Hospital Setting.• Relevant experience may include, but not be limited to experience processing authorizations for services such as: Outpatient authorization requests such as: o Home Health Careo DMEo Ambulatory Procedureso Genetic Testingo Pharmacyo Nutritional supplies Inpatient authorization requests such as : o Acute Hospital Level of Careo Post-Acute level of care reviews (SNF, Acute Rehab, Long Term Acute Care Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. #P01
RN OB/GYN Psych Full-time
Day Kimball Health

Registered Nurse (RN) Job, Part Time Evenings, 32-Hours, Behavioral Health Services

Day Kimball Health Putnam, CT
Day Kimball Health is hiring for a Registered Nurse for the Behavioral Health Services Part Time Evening Shift 32-Hours job in Putnam, CT. Registered Nurse (RN) Benefits: Medical/Dental/Vision Pharmacy Plan Basic & Supplemental Life Insurance Short- & Long-Term Disability Health Savings Account or Flexible Spending Account Accident & Critical Illness Coverage 401K Plan with Eligible Employer Contribution Vacation Time Sick Days Paid Holidays Education Reimbursement Pet Insurance Additional Benefits Registered Nurse (RN) Job Summary: As the Behavioral Health Services Registered Nurse (RN), you will be a vital member of a dynamic team responsible for diagnosing responses to actual or potential health problems and for providing basic emergent, supportive, and restorative care through use of the nursing process. Our nursing model is relationship based, which allows for a stronger connection between the patient and caregiver, and a more individualized, appropriate type of care. You will also discover a culture of teamwork, professionalism, and mutual respect, and—most importantly—a fulfilling career. Registered Nurse (RN) Job Responsibilities: Accountable for planning, implementing, evaluating, and communicating all phases of nursing care for assigned patients in our Psychiatric Inpatient Program. Assesses the health status of patients/families by means of comprehensive health history and physical examination. Initiates selected therapeutic and diagnostic procedures, consultations, and laboratory examination, interprets findings, and alters plan of care according to collaborative practice agreement and protocols in designated area. Educates and counsels in the areas of health promotion, maintenance, disease prevention, and management of acute/chronic illnesses. Documents findings and plan of care in the patient's medical record. Consults with physician per established Day Kimball Hospital policy. Intervenes to provide a safe environment and evaluates effectiveness of intervention for patients. Registered Nurse (RN) Education and Experience Requirements: Graduate of an accredited school of nursing is required. Registered Nurse (RN) license issued by the state of Connecticut is required. American Heart Association Healthcare Provider CPR certification or equivalent is required; if not currently certified, must obtain within three (3) months of employment. Additional specialty certification/training as required by the work area. Current NVCIT (Non-Violent Crisis Intervention Training) certification or within 3 months of hire required. Registered Nurse (RN) Knowledge, Skills and Abilities: Trained and competent in responding to events where a patient is out of control or exhibiting inappropriate behavior; ability to de-escalate volatile situations. Demonstrated level of psychological and emotional tolerance and an even temperament in crisis situations. Knowledge in Psychiatric Nursing. Demonstrated skills in critical thinking, effective communication, organizational skills, problem solving, and ability to make appropriate independent decisions. Working knowledge of applicable Standards of Practice. Demonstrated compassionate customer service and ability to meet the needs and expectations of patients and health care colleagues. Solid foundation in evaluating plans of care and reformulating as necessary. Why Choose Day Kimball Health? The Care You Need. Close to Home. For nearly 130 years, Day Kimball Health has been the trusted healthcare provider for the Northeastern Connecticut community, offering accessible and compassionate care close to home. As a non-profit, integrated healthcare provider, we are committed to delivering high-quality services while maintaining a strong connection with our patients and their families. At Day Kimball, we are passionate about both our patients and our employees. We are growing our talented team every day and offer a supportive, collaborative environment where you can thrive and make a difference. Join us in our mission to elevate community-driven healthcare and be a part of an organization that values both personal and professional growth. Day Kimball Health is an Affirmative Action and Equal Opportunity Employer. We are committed to providing equal employment opportunities to all applicants, regardless of race, color, religion, gender, national origin, age, disability, veteran status, or any other status protected by local, state, or federal laws. Day Kimball Health is a smoke free environment. Are you ready to apply your expertise at the largest employer in Northeastern Connecticut, known for its commitment to excellence in individualized care? Join our team as a Behavioral Health Services Registered Nurse and experience a culture of teamwork, professionalism, mutual respect, and, most importantly, a career that makes a difference! #RegisteredNurse #Nurse #RN #PIPRN #BHRN #BehavioralHealthNurse #PsychiatricInpatientRN