- Humana (Boston, MA)
- …of the appropriate courses of action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in preparation of cases prior to review ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and… more
- Evolent (Boston, MA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Prime Therapeutics (Boston, MA)
- …the future of pharmacy with us. **Job Posting Title** Infusion Referral Nurse Sr- REMOTE **Job Description** Under supervision, is responsible for performing ... and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings and consults with...Qualifications** + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - Care Mgmt… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient advocate between Dana ... Creates cost estimates for waivers. + Rootcauses claim denials, reprocesses, andsubmitsclaim appeals . + Creates drug cost estimates for both on-label and off-label… more
- Fallon Health (Worcester, MA)
- …authorization information in QNXT because of determinations made by Authorization Coordinators, Nurse Reviewers and/or Nurse Care Specialists. + Handles an ... contract information, benefits, etc.), including authorization details when requested for appeals . + Distributes departmental facsimiles; checks Right Fax no less… more