- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals . The Appeals Nurse ... and independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets data obtained from clinical records… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Investigate and resolve medical necessity member appeals . Ensure compliance with state and federal ... Centers for Medicare and Medicaid Services requirements. Maintain all appeals documentation according to external agency requirements. **Supervision Exercised:** +… more
- Baylor Scott & White Health (Boston, MA)
- …**SPECIALTY/DEPARTMENT:** Care Management: Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** Full-time days, Monday-Friday, 8:00 ... vary based on position type and/or level **Job Summary** A Registered Nurse in Nursing Professional Development Generalist role uses expertise to enhance healthcare… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Cell (IEC) therapies, including benefit verification, pre-certification, concurrent review, appeals , and preparation of cost estimates for insurance waivers and ... non-covered services. + Collaborate closely with physicians, nurse coordinators, and interdisciplinary clinical teams to gather and interpret treatment intent,… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient advocate between Dana ... estimates for waivers. + Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label and off-label waivers and… more
- Beth Israel Lahey Health (Burlington, MA)
- …in the context of other Revenue Cycle functions such as Denials & Appeals , Patient Access, Authorization Management & review, HIM, Coding & Billing. Close ... Degree preferred **Licensure, Certification, Registration:** Current license as a Registered Nurse **Skills, Knowledge & Abilities** : + Current and accurate… more
- Tufts Medicine (Melrose, MA)
- …including providing clinical updates to insurance companies. 11. Coordinates insurance appeals related to discharges and adhering to policies and procedures of ... unit quality scores which meet or exceed hospital established targets for nurse sensitive quality indicators as appropriate for the unit. **About MelroseWakefield… more
- Children's Hospital Boston (Boston, MA)
- …for the appropriate level of care for admissions and with post-discharge appeals of payer denials. They identify and implement initiatives to manage utilization ... Management) preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse (RN) + A certification as a Certified Case Manager (or other… more
- Children's Hospital Boston (Boston, MA)
- …for the appropriate level of care for admissions and with post-discharge appeals of payer denials. They identify and implement initiatives to manage utilization ... Management) preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse (RN) + A certification as a Certified Case Manager (or other… more