Utilization Review Nurse - Somerville, 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 ...

+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, · ...

+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 ...

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 ...

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 ...

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. · ...

Travel Utilization Review Registered Nurse · LanceSoft seeks a travel nurse RN Case Management for a 13-week contract. · Job Requirements: · Must have experience in Case Management. · The ideal candidate will have worked as an RN. · ...

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

We are seeking a travel nurse for a 13-week assignment in Everett, Washington. · Current Washington licenseExcellent interpersonal skills including patience empathy and compassionEffective communication skills including active listening writing speaking reading comprehensionFast ...

LanceSoft is seeking a travel nurse RN Case Management for a travel nursing job in Everett, Washington. · Case management experience required · ...

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. ...

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 ensuring compliance with hospital policies regulatory requirements payer guidelines supporting efficient effective utilization review denial management processes collaborating inter ...

The Insurance Support Nurse participates in the timely management of denials that are received in the Care Coordination Department. Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. · For n ...

The Insurance Support Nurse participates in the timely management of denials that are received in the Care Coordination Department.Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. · ...

The Insurance Support Nurse participates in the timely management of denials that are received in the Care Coordination Department. Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. · For n ...

Job Summary · The Insurance Support Nurse participates in the timely management of denials that are received in the Care Coordination Department.Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical re ...