Utilization Review and Appeals Management Specialist

Boston Medical Center is seeking a skilled RN Denials and Appeals Administrator to manage the pre-denial, denial, and appeal processes in accordance with Utilization Review standards.Key Responsibilities:Manage the pre-denial, denial, and appeal processes in accordance with Utilization Review standards.Utilize medical necessity screening tools to conduct...

**Job Overview**Boston Medical Center is seeking a highly skilled RN to manage the denials and appeals process in accordance with utilization review standards.This role involves working closely with payers to secure authorization for clinical services and collaborating with healthcare teams to ensure seamless patient care.Key Responsibilities:Manage...

About Boston Medical CenterBoston Medical Center is seeking a skilled RN Denials and Appeals Administrator to join our team. This individual will be responsible for managing the pre-denial, denial, and appeal processes in accordance with Utilization Review standards.">Key ResponsibilitiesIn this role, you will utilize medical necessity screening tools to...

The RN Denials and Appeals Administrator will play a critical role in ensuring that patients receive necessary care by managing the pre-denial, denial, and appeal processes in accordance with Utilization Review standards.Job Description:As a key member of the team at Boston Medical Center, the RN Denials and Appeals Administrator will be responsible for...

**Job Overview**Boston Medical Center is seeking a highly skilled RN to join our team as a Nurse Care Coordination Specialist.Key Responsibilities:Manage the pre-denial, denial, and appeal processes in accordance with Utilization Review standards.Utilize medical necessity screening tools to conduct initial and continued stay reviews.Collaborate with payers...

About Boston Medical CenterBoston Medical Center is a leading academic medical center that provides exceptional patient care. We are committed to delivering high-quality, compassionate care to our patients and their families.">Job SummaryWe are seeking a skilled RN Denials and Appeals Administrator to join our team. In this role, you will be responsible for...

**Boston Medical Center Job Description**The Boston Medical Center is searching for an experienced RN to fill the role of RN Clinical Denials and Appeals Lead. The ideal candidate will possess strong organizational skills and be able to effectively manage multiple priorities simultaneously.Key Responsibilities: Develop and implement strategies to improve...

At Alfa Insurance Corporate Careers, we're looking for a skilled Document Review Specialist to join our team. As a key member of our document completion process, you will be responsible for reviewing and checking policy documents for accuracy and consistency.The ideal candidate will have strong critical thinking skills, excellent attention to detail, and the...

At Evolent, we seek to connect the pieces of the fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.You will utilize medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU's...

Job SummaryWe are seeking a Clinical Complaints Manager to join our team at Humana. As a key member of our healthcare appeals team, you will be responsible for reviewing clinical complaints and appeals, coordinating clinical resolution, and documenting investigation results. This role requires strong clinical knowledge, analytical skills, and the ability to...

Position SummaryWe are looking for an experienced RN to lead our denials and appeals team at Boston Medical Center.This role offers a unique opportunity to work closely with healthcare teams, payers, and patients to ensure quality patient care and efficient clinical services.Main Responsibilities:Develop and implement effective denials and appeals strategies...

**Overview of the Position**We are seeking a highly skilled Physician Leader to join our team as a Medical Director, responsible for conducting Utilization Management of care received by members in an assigned market, member population, or condition type.The ideal candidate will have a strong background in healthcare management, with experience in...

We're seeking a Sales Floor Stock Specialist to join our dynamic team at Burlington. In this role, you'll be responsible for maintaining the visual appeal of our stores by receiving and processing shipments, organizing merchandise, and displaying products in an attractive manner.With an estimated salary range of $45,000 - $60,000 per year, this is an...

At Cowan Systems and Cowan Management, we are seeking a highly skilled Dispatch Operations Manager to oversee the successful execution of customer freight delivery and daily management of assigned fleets. This leadership position reports directly to the Operations Manager or Terminal Manager, depending on the size of the operation.Key...

Job OverviewCowan Systems, a leader in the transportation industry since 1924, is seeking a skilled Fleet Operations Manager to join our team. As a key member of our operations department, you will be responsible for the successful execution of customer freight delivery and daily oversight of your assigned fleet.About the RoleThis leadership position...

About the Opportunity: Humana Inc. is seeking a highly skilled Medical Director to join our team. As a Medical Director, you will have the opportunity to make a meaningful impact on the lives of our members by ensuring they receive high-quality, medically necessary care.The Ideal Candidate:Has 5+ years of direct clinical patient care experience post...

Cowan Systems and Cowan ManagementEstablished in 1924, Cowan Systems is a privately owned company headquartered in Baltimore, MD, renowned for its excellence and quality in the transportation industry.We are seeking an experienced Operations Manager to oversee our fleet services, ensuring seamless execution of customer freight delivery and daily management...

About UsWe empower professionals to attain financial freedom, enabling them to secure their futures and enjoy their personal lifestyle.We provide the tools, resources, and support necessary for individuals to reach their financial goals.Opportunities:As a Term Life Specialist, you will have opportunities to quickly grow within the company and lead your own...

**About the Role**We are looking for a highly organized and detail-oriented individual to serve as our Outgoing Audit Correspondence Specialist.The successful candidate will be responsible for generating, reviewing, and tracking outgoing audit letters daily using Excel spreadsheets.This role requires strong analytical and problem-solving skills, as well as...

Job SummaryWe are seeking a highly skilled Clinical Consultant for Behavioral Analysis Utilization Management to join our team at CVS Health.About the RoleThis is a challenging and rewarding opportunity to coordinate, monitor, and evaluate options to facilitate appropriate healthcare services for members.As a key member of our team, you will be responsible...