• Utilization Management…

    Humana (Boston, MA)
    **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in… more
    Humana (01/18/26)
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  • Appeals Nurse

    Evolent (Boston, MA)
    …and accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to ... and as an RN - **Required** + Minimum of 5 years in Utilization Management , health care Appeals , compliance and/or grievances/complaints in a quality… more
    Evolent (12/24/25)
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  • UM Regulatory Nurse Specialist, Health New…

    Baystate Health (Springfield, MA)
    …and Coding** : The Nurse Specialist will assist the Utilization Management Department with developing, implementing, and maintaining the compliance ... Nurse Specialist** is responsible for delivering medical or behavioral health utilization management (UM) and coordination of care services to members in… more
    Baystate Health (01/15/26)
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  • Infusion Referral Nurse Sr- REMOTE

    Prime Therapeutics (Boston, MA)
    …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Credentialing criteria. + At ... the future of pharmacy with us. **Job Posting Title** Infusion Referral Nurse Sr- REMOTE **Job Description** Under supervision, is responsible for performing… more
    Prime Therapeutics (01/16/26)
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  • UM Outpatient Clinical Review Nurse…

    Baystate Health (Springfield, MA)
    …Clinical Review Nurse ** contributes to the overall success of the Utilization Management department by performing clinical reviews for outpatient, including ... - Maximum $87,859.00 - $100,984.00 - $119,412.00 **UM Outpatient Clinical Review Nurse - Baystate Health, Health New England** **This is a full-time** **remote… more
    Baystate Health (01/15/26)
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  • Clinical Authorization Specialist

    Dana-Farber Cancer Institute (Brookline, MA)
    …Experience: 1 year of clinical and/or related experience required. Case Management , Utilization Review and/or Prior Authorization experience is preferred. ... Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient advocate between Dana… more
    Dana-Farber Cancer Institute (01/13/26)
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