- 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
- Beth Israel Lahey Health (Burlington, MA)
- …in the resolution of retrospective reimbursement issues, including appeals , third-party payer certification, and denied cases. Monitors effectiveness/outcomes ... as required and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse (RN), Massachusetts + Three years of recent clinical or utilization… 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
- Prime Therapeutics (Boston, MA)
- …leads cross functional committees that review FWA member lock in appeals . **Responsibilities** + Leverage clinical judgement to evaluate members for potential ... years of work experience in case management or professional practice + Current Registered Nurse (RN) license in good standing with the Board of Nursing as required… 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