- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …within regulatory timeframes.The TeamAs an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a liaison and ... healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer... Reviewer is responsible for applying sound clinical judgement to review provider and member… 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 ... internal areas to perform trend analysis; identify reasons for appeals and determine if a review of...audits in preparation of regulatory site visits. + Provide clinical care to members via telehealth technologies (video, chat,… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Immune Effector 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… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and ... clinical and/or related experience required. Case Management, Utilization Review and/or Prior Authorization experience is preferred. + **Certification/Licensure/Registration:**… more
- Children's Hospital Boston (Boston, MA)
- …Posting Description:Department Summary: The UM Case Managers at Boston Children's review documentation within 1 business day of patient admission to assess ... for the appropriate level of care for admissions and with post-discharge appeals of payer denials. They identify and implement initiatives to manage utilization… more
- Beth Israel Lahey Health (Burlington, MA)
- …department in the context of other Revenue Cycle functions such as Denials & Appeals , Patient Access, Authorization Management & review , HIM, Coding & Billing. ... the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities for improvement within… more
- Children's Hospital Boston (Boston, MA)
- …Posting Description:Position Summary: The UM Case Managers at Boston Children's review documentation within 1 business day of patient admission to assess ... for the appropriate level of care for admissions and with post-discharge appeals of payer denials. They identify and implement initiatives to manage utilization… more