- Commonwealth Care Alliance (Springfield, 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 ... care delivery and care coordination for the most complex medical and behavioral health patients. The RN ...fluctuating needs of the defined panel of members, the Registered Nurse will engage in regular assessments,… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... external review agencies, to coordinate activities involved in medical record review , denials, appeals and reconsideration hearings. Works closely with… more
- Beth Israel Lahey Health (Cambridge, MA)
- …regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer review . 5. Excellent understanding of clinical aspects of ... reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review ...collect data for reporting quality measures, including both concurrent medical record review and periodic medical… more
- Fallon Health (Worcester, MA)
- …or healthcare setting preferred. **License/Certifications:** Active, unrestricted license as a Registered Nurse In Massachusetts **Experience:** + A minimum of ... not limited to preservice, concurrent and retrospective reviews for medical necessity or benefit review . Along with...three to five years' clinical experience as a Registered Nurse , in a clinical setting required.… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Primary responsibility for performing daily medical reviews, appeals as appropriate, correspondence regarding review determinations and physician ... Director of Medical Policy and Utilization Review , the Utilization Review Medical ...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- Prime Therapeutics (Boston, MA)
- …Patient Programs. **Education & Experience** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings and consults with...for work visa or residency sponsorship. **Additional Qualifications** + Registered Nurse ( RN ). + 5… more
- State of Massachusetts (Boston, MA)
- …(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) of which ... to support departmental effectiveness. * Regularly interface with the medical staff to review patient care appropriateness...of nursing must have applied for the first available registered nurse examination. Special Requirements: Based on… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient...more complex inquiries. + Assists Drug Authorization Specialists with medical necessity denial review : + Ensures that… more
- Beth Israel Lahey Health (Burlington, MA)
- …Degree, Master's Degree preferred **Licensure, Certification, Registration:** Current license as a Registered Nurse **Skills, Knowledge & Abilities** : + Current ... department in the context of other Revenue Cycle functions such as Denials & Appeals , Patient Access, Authorization Management & review , HIM, Coding & Billing.… more