• 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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  • Care Transitions Jobs

    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 (07/03/25)
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  • Per Diem RN Case Manager…

    Children's Hospital Boston (Boston, MA)
    …Posting Title:Per Diem RN Case Manager , Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard ... denials . They identify and implement initiatives to manage utilization trends, collaborating with the hospital's discharge planning case managers, healthcare… more
    Children's Hospital Boston (06/16/25)
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  • Manager Utilization Management

    Beth Israel Lahey Health (Burlington, MA)
    …collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities ... the context of other Revenue Cycle functions such as Denials & Appeals, Patient Access, Authorization Management & ...Responsibilities** _including but not limited to:_ + Ensures that Utilization Review nurses are consistently recommending the… more
    Beth Israel Lahey Health (06/06/25)
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  • Registered Nurse - Utilization…

    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 (05/17/25)
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  • RN, Hospital Case Manager Full Time

    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 ... The **RN Hospital Case Manager ** is a registered nurse responsible for the...for transitions + Leads the team to ensure appropriate utilization of patient resources and directs care to other… more
    Baystate Health (06/25/25)
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  • Clinical Authorization Specialist

    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
    Dana-Farber Cancer Institute (07/01/25)
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