• Manager - Utilization Review & Denials Management

    Beth Israel Lahey Health (Plymouth, MA)
    …and determines appropriate strategy in response to reimbursement denials. + Responsible for appeals and follow up on clinical denials escalated through a work ... queue, providing appropriate response supported by clinical information. + Provides oversight of the appeals process and direction regarding appeals and… more
    Beth Israel Lahey Health (07/29/25)
    - Related Jobs

  • Director Case Management

    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 ... include the development and supervision of staff (RNs, LPN's,SWs and non- clinical support), evaluation and maintenance of case management skills and outcomes,… more
    Brockton Hospital (09/12/25)
    - Related Jobs

  • Medication Reconciliation Technician - Sign…

    Tufts Medicine (Melrose, MA)
    …of upcoming prescription refills and informs them of prior authorizations or appeals process. 7. Refers patients' concerns requiring clinical interpretation to ... focuses on support of daily business activities (eg, technical, clinical , non- clinical ) operating in a "hands on"...This position requires frequent communication with providers (MD, RPh, RN , NP, PA) on changes in adherence as well… more
    Tufts Medicine (10/12/25)
    - Related Jobs

  • Utilization Nurse

    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 (08/15/25)
    - Related Jobs