- 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 (Plymouth, MA)
- …is expanding its **Care Transitions Department** and seeking an experienced ** Manager of Utilization Review & Denials Management** and ** Utilization ... or other case management certification preferred or in progress ** Manager - Utilization Review & Denials Management** This role is ideal for a Manager… more
- 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 (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
- State of Massachusetts (Boston, MA)
- …delivery of health care services through networks of providers, or that employ utilization review systems to evaluate the medical necessity and appropriateness ... applications for licensure. Review is of carriers' operations, including utilization review , quality assurance, contracts with pharmacies and prescription… more
- Baystate Health (Springfield, MA)
- …and Competencies:** + Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by third party payers ... + **Per Diem Hospital Case Manager ** The **RN Hospital Case Manager **...for transitions + Leads the team to ensure appropriate utilization of patient resources and directs care to other… more
- Beth Israel Lahey Health (Beverly, MA)
- …functions include concurrent and retrospective review to assure appropriate utilization , assessment, prevention of denials and coordination of discharge ... options. They are required to follow specific criteria sets to assure regulatory compliance. They coordinate safe discharge plans between the health care delivery team, patients, families, insurers and continuing care agencies. **Education/Experience:** 1.… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …+ 1 year of clinical and/or related experience required. Case Management, Utilization Review and/or Prior Authorization experience is preferred. + ... The Clinical Authorization Specialist is also responsible for managing denials related to front-end prior authorization, biosimilar drugs, pharmacy-benefit exclusion… more
- Beth Israel Lahey Health (Burlington, MA)
- …. . Assists Utilization Managers with all aspects of utilization review /discharge planning/performance improvement processes. . Functions as liaison for ... including Interqual, Rightfax, NaviHealth, Change Healthcare, Epic, etc. . Manages all utilization management work queues by researching and following up on all… more
- Beth Israel Lahey Health (Burlington, MA)
- …making a difference in people's lives.** Reporting to the Coding and Billing Manager , the Coding and Billing Analyst serves as the preeminent analytical coding ... workflows, this position requires an advanced-level knowledge of the utilization of ICD-10 and CPT coding principles in the...Locate patterns and trends by focusing on high volume denials that have a common denominator. Analyze root cause… more
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