- Evolent (Boston, MA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse 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… 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
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Investigate and resolve medical necessity member appeals . Ensure compliance with state and federal ... Centers for Medicare and Medicaid Services requirements. Maintain all appeals documentation according to external agency requirements. **Supervision Exercised:** +… 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 ... cases that do not meet established guidelines for admission or continued stay. + Acts as a liaison between physicians and payers, coordinating peer-to-peer phone calls. + Collects and compiles data as required. _It is understood that this is a summary of key… 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 ... cases that do not meet established guidelines for admission or continued stay. + Acts as a liaison between physicians and payers, coordinating peer-to-peer phone calls. + Collects and compiles data as required. _It is understood that this is a summary of key… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Cell (IEC) therapies, including benefit verification, pre-certification, concurrent review, appeals , and preparation of cost estimates for insurance waivers and ... non-covered services. + Collaborate closely with physicians, nurse coordinators, and interdisciplinary clinical teams to gather and interpret treatment intent,… more
- Beth Israel Lahey Health (Burlington, MA)
- …in the context of other Revenue Cycle functions such as Denials & Appeals , Patient Access, Authorization Management & review, HIM, Coding & Billing. Close ... Degree preferred **Licensure, Certification, Registration:** Current license as a Registered Nurse **Skills, Knowledge & Abilities** : + Current and accurate… more
- Children's Hospital Boston (Boston, MA)
- …for the appropriate level of care for admissions and with post-discharge appeals of payer denials. They identify and implement initiatives to manage utilization ... Management) preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse (RN) + A certification as a Certified Case Manager (or other… more
- Tufts Medicine (Lowell, MA)
- …issues, including providing clinical updates to insurance companies. + Coordinates insurance appeals related to discharges and adhering to policies and procedures of ... unit quality scores which meet or exceed hospital established targets for nurse sensitive quality indicators as appropriate for the unit. **About Lowell General:**… more
- Brockton Hospital (Brockton, MA)
- …agencies, to coordinate activities involved in medical record review, denials, appeals and reconsideration hearings. Works closely with the physician advisor to ... EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is reasonable to… more