- Commonwealth Care Alliance (Boston, MA)
- …complexities that require intensive care management and care delivery. Within the CIC Program, the Registered Nurse ( RN ) serves as an integral member of an ... and based on the fluctuating needs of the defined panel of members, the Registered Nurse will engage in regular assessments, visits at regularly scheduled… more
- CenterWell (Boston, MA)
- …or requested. **Use your skills to make an impact** **Required Experience/Skills:** + Registered Nurse or Physical Therapist. + Current state license as a ... and monitoring all payer requests for additional documentation (ADR), appeals and denials. Works with branch staff to gather... Registered Nurse or Physical Therapist. + 5… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound clinical judgement to ... integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a...to assist with medical necessity determinations. Key Qualifications: + Registered Nurse with an active unrestricted professional… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances team ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
- Beth Israel Lahey Health (Plymouth, MA)
- …team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding ... job that may reasonably be required._ **Education/Experience Required:** + Current MA RN licensure + Bachelor's Degree in Nursing or advanced degree in healthcare… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA and other...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- State of Massachusetts (Boston, MA)
- …at least (A) three years of full-time, or equivalent part-time, experience as a registered nurse in a recognized hospital, clinic or medical facility and (B) ... an approved school of nursing must have applied for the first available registered nurse examination. Special Requirements: Based on assignment, possession of a… 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
- Tufts Medicine (Lowell, MA)
- **Job Overview** The RN Case Manager manages a designated caseload to coordinate and complete timely assessment, planning, implementation and evaluation of discharge ... hours/week Location: Saints or Main campus **Job Description** **Minimum Qualifications:** 1. Massachusetts RN Licensure. 2. 3 Years of RN Experience. 3. Current… more
- Tufts Medicine (Melrose, MA)
- …to work close to home with a community hospital. **Job Overview** The RN Case Manager manages a designated caseload to coordinate and complete timely assessment, ... Flexibility between 8am-4:30pm Rotating Weekends **Job Description** **Minimum Qualifications:** 1. Massachusetts RN Licensure. 2. 3 Years of RN Experience. 3.… more
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