- 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
- 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
- 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 ... professionals, resolving difficult and sometimes complex problems. **Job Overview** The RN Case Manager manages a designated caseload to coordinate and complete… 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
- 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