- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound ... an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will...to assist with medical necessity determinations. Key Qualifications: + Registered Nurse with an active unrestricted professional… more
- Commonwealth Care Alliance (Boston, MA)
- …complexities that require intensive care management and care delivery. Within the CIC Program, the Registered Nurse ( RN ) serves as an integral member of an ... fluctuating needs of the defined panel of members, the Registered Nurse will engage in regular assessments,...and addresses significant medical, behavioral, and social needs. The RN uses evidenced-based care approaches, clinical skills,… more
- State of Massachusetts (Boston, MA)
- …at least (A) three years of full-time, or equivalent part-time, experience as a registered nurse in a recognized hospital, clinic or medical facility and (B) ... an approved school of nursing must have applied for the first available registered nurse examination. Special Requirements: Based on assignment, possession of a… more
- Prime Therapeutics (Boston, MA)
- …visa or residency sponsorship. **Additional Qualifications** + Registered Nurse ( RN ). + 5 years of post-degree clinical experience. + Experience in ... these cases in web-based application and spreadsheets. + Supports clinical services such as the appeals program....+ Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State… 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
- Tufts Medicine (Melrose, MA)
- …providing clinical updates to insurance companies. 11. Coordinates insurance appeals related to discharges and adhering to policies and procedures of Medicare ... to home with a community hospital. **Job Overview** The RN Case Manager manages a designated caseload to coordinate...scores which meet or exceed hospital established targets for nurse sensitive quality indicators as appropriate for the unit.… 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
- Tufts Medicine (Lowell, MA)
- …providing clinical updates to insurance companies. + Coordinates insurance appeals related to discharges and adhering to policies and procedures of Medicare ... **Job Overview** The RN Case Manager manages a designated caseload to...scores which meet or exceed hospital established targets for nurse sensitive quality indicators as appropriate for the unit.… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals... clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient… more
- Beth Israel Lahey Health (Burlington, MA)
- …Degree, Master's Degree preferred **Licensure, Certification, Registration:** Current license as a Registered Nurse **Skills, Knowledge & Abilities** : + Current ... of other Revenue Cycle functions such as Denials & Appeals , Patient Access, Authorization Management & review, HIM, Coding...and workflows and works closely with other administrative and clinical areas under the direction of the Executive Director… more