Medical Review and Appeals RN - Boston, MA

We envision a bold future for American healthcare at UST HealthProof.We come with an open mind and straightforward approach, · simplifying complexity underlines everything we do—this approach is what makes us unique. · Perform prospective concurrent retrospective review to ensure ...

The Nurse Manager for Utilization Review and Clinical Appeal Management oversees daily operations of UM and Appeal teams ensuring compliance with hospital policies regulatory requirements payer guidelines. This role supports efficient effective utilization review denial managemen ...

The Nurse Manager for Utilization Review and Clinical Appeal Management is responsible for overseeing the daily operations of the Utilization Management (UM) and Clinical Appeal teams. · ...

The Nurse Manager oversees daily operations of Utilization Management (UM) and Clinical Appeal teams. · Collaborates with interdisciplinary teams to reduce payer denials.Provides leadership, staff training, and quality improvement initiatives. ...

The Nurse Manager oversees daily operations of Utilization Management UM and Clinical Appeal teams ensuring compliance with hospital policies regulatory requirements payer guidelines supporting efficient effective utilization review denial management processes collaborating inter ...

· This is NOT the ECT&E/E&E application. This application is reserved for candidates who participated in a promotional examination and would like to file an appeal. Please check your email for instructions and links to the E&E/ECT&E application for the promotional examination yo ...

The RN Appeal Administrator will be responsible for the Pre-denial/Denial and appeal process in addition to Utilization Review,to validate the patient's placement to be at the most appropriate level of care based on nationally accepted admission criteria.The Appeal/UR Administrat ...

The RN Appeal Administrator will be responsible for the Pre-denial/ Denial and appeal process in addition to Utilization Review. · Uses medical necessity screening tools to complete initial and continued stay reviews. · Secures authorization for patient’s clinical services throug ...

We're hiring a Member Appeals Specialist to support a high-volume health plan appeals team. · This role focuses on member appeals for pre-service pharmacy coverage (non-Medicare) and requires strong attention to detail, case management skills, and comfort working in a fully virtu ...

The Nurse Manager for Utilization Review and Clinical Appeal Management ensures compliance with hospital policies regulatory requirements payer guidelines while supporting efficient effective utilization review denial management processes. · Collaborates with interdisciplinary te ...

The Review Examiner I is responsible for conducting hearings on appeals of claims for agency services or benefits; promptly preparing and implementing decisions on hearings conducted; documenting information and evidence; preparing reports, including decisions on hearings conduct ...

Job summary · We are seeking a detail-oriented Collections Specialist to join our team. In this role you'll be responsible for reviewing cash receipts handling attorney appeals and ensuring timely follow-ups on overdue balances The ideal candidate will be organized proactive and ...

The Nurse Manager for Utilization Review and Clinical Appeal Management is responsible for overseeing the daily operations of the Utilization Management (UM) and Clinical Appeal teams. This role ensures compliance with hospital policies, regulatory requirements, · Leadership & Op ...

+The Federal Public Defender Office for the Districts of Massachusetts, New Hampshire, and Rhode Island is hiring an experienced trial attorney to be a full-time Assistant Federal Public Defender (AFPD) in the Boston Office. · ...

+Job summaryThe Committee for Public Counsel Services seeks applicants to fill two positions in the Private Counsel Division's Criminal Appeals Unit. · +QualificationsMust be eligible to practice law in this jurisdiction as a member of the Massachusetts Bar in good standing, · ...

We're hiring a Member Appeals Specialist to support a high-volume health plan appeals team. This role focuses on member appeals for pre-service pharmacy coverage and requires strong attention to detail, case management skills, and comfort working in a fully virtual environment. · ...

The Committee for Public Counsel Services, the public defender agency for Massachusetts, is seeking applicants from experienced attorneys to fill two newly created positions in the Private Counsel Division's Criminal Appeals Unit.We fight for equal justice and human dignity by su ...

Our client is seeking a detail-driven Member Appeals Specialist who thrives in a structured, process-oriented environment and communicates with clarity and empathy. This role is fully remote. · ...

The Committee for Public Counsel Services is seeking applicants from experienced attorneys to fill two newly created positions in the Private Counsel Division's Criminal Appeals Unit. · The Post-Conviction Oversight Attorneys will provide support and oversight to members of the p ...

we are seeking two experienced practitioners who will provide support and oversight to members of the post-conviction panel in criminal appeals unit at committee for public counsel services in boston us. · ...