- 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)
- …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
- Beth Israel Lahey Health (Plymouth, MA)
- …establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical ... team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding… 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
- Beth Israel Lahey Health (Plymouth, MA)
- …establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical ... 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)
- …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