- Cognizant (Boston, MA)
- …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… more
- Beth Israel Lahey Health (Charlestown, MA)
- …important role in a high-profile team tasked with handling all commercial and government clinical appeals and audit processes. The Clinical Analyst will ... and procedures; to gather information that would support submitted charges. Prepare clinical appeals relevant to the audits in order to prove… more
- Evolent (Boston, MA)
- …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- Beth Israel Lahey Health (Cambridge, MA)
- …high reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, ... skills to prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer review.… more
- Beth Israel Lahey Health (Boston, MA)
- …directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse ( RN ), Massachusetts + Three years of recent clinical or utilization management ... Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on the… more
- 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 addresses significant medical, behavioral, and social needs. The RN uses evidenced-based care approaches, clinical skills,...including: + 5+ years' experience as Registered Nurse in a high touch clinical environment… more
- Fallon Health (Worcester, MA)
- …Degree in nursing, or equivalent. **License:** Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience:** Three to five years of ... of clinical criteria and medical necessity determinations. The Appeal Nurse is responsible for ensuring compliance with all applicable state and federal… more
- Beth Israel Lahey Health (Plymouth, MA)
- …establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical ... team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding… more
- Beth Israel Lahey Health (Plymouth, MA)
- …concurrent and retrospective reviews for level of care and continued stay * Lead appeals of clinical denials and collaborate with physician advisors * Coordinate ... and insurers * Collect data and support denial prevention strategies * Integrate clinical and reimbursement knowledge for optimal outcomes ** RN Case Manager -… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals... clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient… more