Preservice Review Nurse RN - Boston, MA

We are seeking a talented individual for a Nurse Reviewer (RN) to support our Massachusetts contract. This role involves performing clinical reviews to determine if the medical record documentation supports the need for the service based on clinical criteria, coverage policies, a ...

The Utilization Review Nurse will utilize clinical knowledge to analyze, assess and render approval decisions for physician review as well as complete determinations following physician review. · ...

+Job summary · The UMCM will utilize clinical knowledge to analyze, assess, · and render approval decisions,+Review authorization requests for medical services, · including making initial eligibility and coverage determinations, · ...

+Job summary · We are seeking a Preservice Review Nurse RN to perform pre-service/prior authorization clinical coverage review of Home Health services. · +Determine the appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit det ...

The Preservice Review Nurse RN is responsible for evaluating the appropriateness of inpatient and outpatient services based on medical guidelines and benefit determination, identifying solutions to non-standard requests and problems, and collaborating with leadership and team mem ...

+The Preservice Review Nurse RN is responsible for evaluating the appropriateness of inpatient and outpatient services based on medical guidelines and benefit determination. · +Determine the appropriateness of inpatient and outpatient services following evaluation of medical guid ...

Reliable Nurse Staffing is seeking a travel nurse RN Case Manager for a travel nursing job in Everett. · Weekly pay · Holiday Pay · ...

Access Healthcare is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job. · ...

Solomon Page is seeking a travel nurse RN Case Manager for a travel nursing job in Everett, Washington. · ...

Solomon Page is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Everett, Washington. · Specialty: Utilization Review · ...

We are seeking Medical Analysts with experience in preparing Medicare Set Asides and Medical Cost Projections. · Reviews records to prepare narratives and allocations for medical treatment. · Demonstrates knowledge of CMS policies related to preparing MSAs. · ...

We are seeking Medical Analysts with experience in preparing Medicare Set Asides and Medical Cost Projections. · Through a review of relevant medical files and related documentation, provides a narrative and cost projection for future treatment related to Workers Compensation and ...

LanceSoft is seeking a travel nurse RN Case Management for a travel nursing job in Everett. · ...

We are seeking Medical Analysts with experience in preparing Medicare Set Asides and Medical Cost Projections. This includes reviewing records, preparing the narrative and an appropriate allocation for medical treatment and prescription medications. · Candidates will demonstrate ...

Discharge planning educate providers on utilization and medical management provide clinical knowledge perform onsite review of emergent urgent and continued stay requests. · ...

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 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 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. ...

We are seeking a travel nurse RN Case Manager Utilization Review for a travel nursing job in Everett Washington. · Care Career brings together leading healthcare staffing organizations delivering specialized talent solutions across the industry where you want to go we make it hap ...

ALOIS Healthcare is seeking a travel nurse RN Utilization Review for a travel nursing job in Everett, Washington. · Job Description & Requirements · Specialty: · Utilization Review · Discipline: · RN · Start Date: · 03/02/2026 · Duration: · 13 weeks · 40 hours per week · Shift: · ...