- Beth Israel Lahey Health (Needham, MA)
- …in the resolution of retrospective reimbursement issues, including appeals , third-party payer certification, and denied cases. Monitors effectiveness/outcomes ... as required and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse (RN), Massachusetts + Three years of recent clinical or utilization… more
- Beth Israel Lahey Health (Burlington, MA)
- …in the resolution of retrospective reimbursement issues, including appeals , third-party payer certification, and denied cases. Monitors effectiveness/outcomes ... as required and directed. **Qualifications:** Required Licensure as a Registered Nurse (RN), Massachusetts Three years of recent clinical or utilization management… 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
- Elevance Health (Woburn, MA)
- …and providers. **Job Summary:** + Perform physician-level case review, following initial nurse review, of Medical Oncology regimens and supportive care. + Perform ... physician-level case review, following initial nurse review, of chemotherapy regimens. + Determine medical necessity...a subject matter expert. + Perform first level provider appeals as designated by the client for adverse determinations.… more
- Beth Israel Lahey Health (Boston, MA)
- …data analysis on audit trends, scrubber data, government audit requests, denials/ appeals as well as developing and implementing corrective action plans for ... presentations/training sessions. Develops and administers ongoing physician, fellow and nurse practitioner education training sessions including documentation guidelines, new/revised/deleted… 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