- Prime Therapeutics (Boston, MA)
- …and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing ... web-based application and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings and consults with management on regular… more
- Sharecare, Inc. (Boston, MA)
- …or assist member in working with payer to complete prior authorization or appeals process, when necessary. + Abide by Clinical Advocacy Program Description and ... patient and provider outcomes **Qualifications:** + Current multi-state/compact Registered Nurse licensure in state of residence is required, with ability… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …a member and provider call center, provider correspondence and appeals , clinical review, member correspondence and reconsiderations, enrollment, claims processing, ... Post Service Review Manager , led by a Registered Nurse , is responsible for a team of provider correspondence...associates who research and respond to provider inquires and appeals , build cases, and perform claim adjustments in a… more
- Sharecare, Inc. (Boston, MA)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Sedgwick (Boston, MA)
- …client or facility to obtain additional or missing information. + Handles provider appeals as appropriate to fee schedule and contractual disputes. + Identifies and ... review experience in multi-state jurisdiction; prior experience in PPO provider appeals , re-pricing, surgery review, by report and RNE review; two (2)… more
- Tarrytown Rehabilitation & Nursing Center (Everett, MA)
- …process for MDS and MMQ vacancies. Qualifications: + Licensed as a Registered Nurse in the State of Massachusetts + Three to Five years of clinical ... knowledge (Medicaid, Medicare) and case management process (prior authorization and appeals ) required + Ability to multi-task and adapt to changing priorities… more
- Brockton Hospital (Brockton, MA)
- …agencies, to coordinate activities involved in medical record review, denials, appeals and reconsideration hearings. Works closely with the physician advisor to ... EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is reasonable to… more