- Commonwealth Care Alliance (Boston, MA)
- …and sound clinical judgment in reviewing medical records and writing appeals . + Participate in telephonic Administrative Law Judge Hearings and present oral ... 011540 CCA- Appeals & Grievances **Position Summary:** Investigate and resolve...audits in preparation of regulatory site visits. + Provide clinical care to members via telehealth technologies (video, chat,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …us transform healthcare? Bring your true colors to blue. The RoleThe Senior Clinical Appeals Nurse Reviewer Supervisor facilitates, coordinates, and responds ... clinical , regulatory, business, and coding knowledge. The Senior Clinical Appeals Nurse Reviewer Supervisor...provides support and assistance as needed. Key Qualifications: + Registered Nurse with certified coding experience and… more
- Children's Hospital Boston (Boston, MA)
- …or Utilization Management) preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse ( RN ) + A certification as a Certified ... 80451BRJob Posting Title:Per Diem RN Case Manager, Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard… more
- Children's Hospital Boston (Boston, MA)
- …or Utilization Management) preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse ( RN ) + A certification as a Certified ... 80501BRJob Posting Title:Behavioral Health RN Case Manager - 20hrsDepartment:Patient Services-Patient Care OperationsAutoReqId:80501BRStatus:Part-TimeStandard Hours… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Therapy and/or Prior Authorization experience is preferred. + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. **KNOWLEDGE, SKILLS, ... for insurance waivers and non-covered services. + Collaborate closely with physicians, nurse coordinators, and interdisciplinary clinical teams to gather and… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... include the development and supervision of staff (RNs, LPN's,SWs and non- clinical support), evaluation and maintenance of case management skills and outcomes,… more