• Manager - Utilization Review…

    Beth Israel Lahey Health (Plymouth, MA)
    …you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding UR… more
    Beth Israel Lahey Health (04/29/25)
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  • Utilization Management Operations…

    Tufts Medicine (Burlington, MA)
    …**Job Overview** The position provides day to day support and oversight to Utilization Review departments and UM vendor management. Responsible for compliance ... with CMS Conditions of Participation regarding Utilization Review and Discharge Planning including implementation and annual review of the Utilization … more
    Tufts Medicine (05/03/25)
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  • Utilization Nurse

    Beth Israel Lahey Health (Plymouth, MA)
    …care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care ... the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established… more
    Beth Israel Lahey Health (03/09/25)
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  • Revenue Cycle Manager

    Robert Half Finance & Accounting (Shrewsbury, MA)
    Description The Revenue Cycle Manager is responsible for overseeing and optimizing the end-to-end revenue cycle processes, a Federally Qualified Health Center (FQHC) ... standards, KPIs, and SLAs related to vendor performance. * Review and escalate vendor issues that impact cash flow...challenges and/or breakdowns in the revenue cycle process causing denials or delayed payments. * Perform ongoing trend analysis… more
    Robert Half Finance & Accounting (05/02/25)
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  • Telephonic UM Administration Coordinator

    Humana (Boston, MA)
    …with medical terminology and/or ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... Process provider and member letters (Letter of Agreements, Approvals, Denials etc.) + Mail letters to members. + Assist...in special projects as assigned by your Supervisor or Manager . **Use your skills to make an impact** Additional… more
    Humana (05/11/25)
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