- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …within regulatory timeframes.The TeamAs an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a liaison and ... healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer... Reviewer is responsible for applying sound clinical judgement to review provider and member… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Senior Clinical Appeals Nurse Reviewer Supervisor facilitates, coordinates, and ... clinical , regulatory, business, and coding knowledge. The Senior Clinical Appeals Nurse Reviewer...and Medical and Payment Policy teams. Key Responsibilities: + Review appeals utilizing sound clinical … more
- Beth Israel Lahey Health (Plymouth, MA)
- …data to establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal ... team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding… more
- Beth Israel Lahey Health (Plymouth, MA)
- …data to establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal ... team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding… more
- Brockton Hospital (Brockton, MA)
- …external review agencies, to coordinate activities involved in medical record review , denials, appeals and reconsideration hearings. Works closely with the ... 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