- 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
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Investigate and resolve medical necessity member appeals . Ensure compliance with state and federal ... Centers for Medicare and Medicaid Services requirements. Maintain all appeals documentation according to external agency requirements. **Supervision Exercised:** +… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Cell (IEC) therapies, including benefit verification, pre-certification, concurrent review, appeals , and preparation of cost estimates for insurance waivers and ... non-covered services. + Collaborate closely with physicians, nurse coordinators, and interdisciplinary clinical teams to gather and interpret treatment intent,… 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
- Children's Hospital Boston (Boston, MA)
- …for the appropriate level of care for admissions and with post-discharge appeals of payer denials. They identify and implement initiatives to manage utilization ... Management) preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse (RN) + A certification as a Certified Case Manager (or other… more