- Evolent (Boston, MA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact ... as part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to… more
- Evolent (Boston, MA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Sharecare (Boston, MA)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Beth Israel Lahey Health (Burlington, MA)
- …in the context of other Revenue Cycle functions such as Denials & Appeals , Patient Access, Authorization Management & review, HIM, Coding & Billing. Close ... Degree preferred **Licensure, Certification, Registration:** Current license as a Registered Nurse **Skills, Knowledge & Abilities** : + Current and accurate… more
- Tufts Medicine (Melrose, MA)
- …including providing clinical updates to insurance companies. 11. Coordinates insurance appeals related to discharges and adhering to policies and procedures of ... unit quality scores which meet or exceed hospital established targets for nurse sensitive quality indicators as appropriate for the unit. **About MelroseWakefield… more
- Tufts Medicine (Lowell, MA)
- …issues, including providing clinical updates to insurance companies. + Coordinates insurance appeals related to discharges and adhering to policies and procedures of ... unit quality scores which meet or exceed hospital established targets for nurse sensitive quality indicators as appropriate for the unit. **About Lowell General:**… more