Appeals RN: Utilization Review & Pathway Navigator
JobsInMass.com
JobsInMass.com is seeking an Appeals RN to join hospitals in the Boston, MA area. The role focuses on clinical pathway, navigator, or utilization review responsibilities and offers day shifts with full-time, part-time, and per-diem options. Ideal candidates hold an RN Diploma or higher and a Massachusetts RN license in good standing, with healthcare benefits and a path to growth within a medical setting. #J-18808-Ljbffr JobsInMass.com
Vacancy posted 1 day ago
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$38.11 - $98.61 per hour
...the admitting/attending physician, the Utilization Review RN assists in determining the appropriate... ...reimbursement issues, including appeals, third-party payer certification, and... ...Possesses mid to high-level proficiency in navigating the Electronic Medical Record and applications...SuggestedHourly payFull timeLocal areaShift workBeth-Israel-Lahey-Health
Boston, MA4 days ago$75k - $150k
...applications in the Boston, MA area for the following position: Appeals RN. Nurses with experience in any of the following areas are strongly encouraged to apply: Clinical pathway, Navigator, or Utilization Review. Shift and Employment Shift(s) available: day shift Job...SuggestedDaily paidFull timePart timeShift workDay shift- ...of admission type and setting, utilizing a combination of clinical... ...InterQual guidelines. The Utilization Review Nurse utilizes clinical... ...denial notification, and expedited appeals. Has access to highly... ...Minimum two years experience as an RN (preferred). Minimum at least...SuggestedWork at office
$2,989 - $3,084 per week
...Registered Nurse (RN) | Utilization Review Location: Everett, MA Agency: GQR Healthcare Pay: $2,989 to $3,084 per week Shift Information: Days Contract Duration: 13 Weeks Start Date: ASAP About the Position TravelNurseSource is working...SuggestedHourly payWeekly payFull timeContract workImmediate startShift workTravelNurseSource
Everett, MA21 hours ago$2,989 - $3,084 per week
...Registered Nurse (RN) | Utilization Review Location: Everett, MA Agency: GQR Healthcare Pay: $2,989 to $3,084 per week Shift Information: Days Contract Duration: 13 Weeks Start Date: ASAP About the Position Contract - W2 Case Management...SuggestedHourly payWeekly payFull timeContract workImmediate startShift workGQR Healthcare
Everett, MA21 hours ago- ...Mass Digital Health is seeking a Utilization Review Nurse in Quincy, Massachusetts. This role involves evaluating patients for appropriate admission... ...coordination. This position requires at least two years of RN experience in care management or utilization management. The...
Mass Digital Health
Quincy, MA1 day ago - ...Plan in Boston is looking for an Inpatient Utilization Management Clinician to evaluate inpatient... .... The ideal candidate will have an active RN license, a bachelor's degree in nursing, and at least 2 years of utilization review experience. Join WellSense in helping our...Remote work
Well Sense Health Plan
Boston, MA21 hours ago $1,787 per week
Supplemental Health Care is seeking a travel nurse RN Acute Care Case Management for a travel nursing job in Boston, Massachusetts... ...Health Care is hiring experienced Non-patient Care (utilization Review) RNs for contract opportunities at a leading Level 1 trauma center...Contract workLocal areaImmediate startShift work- Beth Israel Lahey Health is hiring a Utilization Review RN in Boston, MA. This per diem position requires collaboration with the health care team to evaluate patient admissions based on medical necessity, ensuring effective utilization management. The ideal candidate will...Daily paid
$38.11 - $98.61 per hour
Beth Israel Deaconess Medical Center is looking for a full-time Utilization Review RN in Boston, MA. In this role, you'll collaborate with physicians to ensure appropriate admission status while performing utilization management reviews. The position requires a valid Massachusetts...Hourly payFull time- USI Insurance Services seeks an experienced RN Utilization Review Nurse to assess workers' compensation care for MA licensure holders. Remote opportunities exist for East Coast candidates with MA licensure. The role evaluates medical necessity, ensures guideline adherence...Remote job
- ...Coordinator. The Registered Nurse (Rn) Assesses, Plans, Implements,... ...Service, Teamwork, Resource Utilization, And Staff And Self... ...Development As Outlined In Performance Review. # Performs Other Duties As... ...support services needed to navigate their cancer journey...
Yale New Haven Health
Cambridge, MA21 hours ago $84.3k - $107.48k
...performing the following Nurse Navigator duties: Focuses on the... ...limited supervision, coaching and reviewing the work of lower level professionals... ...2. Registered Nurse (RN) license. 3. Basic Life... ...drivers of avoidable utilization of Emergency Department (ED)...Work experience placementTufts Medicine
Boston, MA11 days ago$28.94 - $51.83 per hour
...Clinical Appeals RN Optum is a global organization that delivers care, aided by technology... .../prior authorization clinical coverage review of services. Works closely with managers... ...prior authorization decisions by utilizing program specific regulations, medical necessity...Remote jobHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal area- ...(PHSO) as a Registered Nurse Navigator (RNN) focused on high-risk and... ...unnecessary post-acute care utilization and readmissions.The RNN will... ..., promoting appropriate care pathways, support APPs and geriatricians... ...backgroundRegistered Nurse (RN) licensure in Massachusetts (...Full timeRemote workMonday to FridayFlexible hours3 days per week
$41.36 - $100 per hour
...facilitate a safe cost-effective transition post discharge. Performs all aspects of audits and appeals including the peer to peer process. - Perform utilization review to evaluate for appropriate level of care and faxes all insurance reviews timely to prevent...Hourly payDaily paidRemote workShift workMass General Brigham
Boston, MA3 days ago- ...Saint Raphael Campus Medicine MICU / SDU RN Pathway Designed for Medicine RNs interested in... ...expectations for customer service, teamwork, resource utilization, and staff and self development as outlined in performance review. # Performs other duties as assigned or...
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Cambridge, MA21 hours ago $41.36 - $100 per hour
...to facilitate a safe cost-effective transition post discharge. Performs all aspects of audits and appeals including the peer to peer process. - Perform utilization review to evaluate for appropriate level of care and faxes all insurance reviews timely to prevent denials...Hourly payDaily paidRemote workShift workMass General Brigham
Jamaica Plain, MA2 days ago- ...to facilitate a safe cost-effective transition post discharge. Performs all aspects of audits and appeals including the peer to peer process. - Perform utilization review to evaluate for appropriate level of care and faxes all insurance reviews timely to prevent...Daily paid
Brigham & Women's Faulkner Hospital
Boston, MA4 days ago - American Traveler is hiring a travel RN for a Care Management position in Boston, MA, requiring a BSN, 3+ years of case management... ...CCM or related certification preferred 5+ years of utilization management (UM) and case management (CM) experience preferred...Local areaWeekend workDay shift
- Massachusetts General Hospital in Boston seeks a Per Diem RN for Utilization Management. A MA Registered Nurse State License is required. As an Equal Opportunity Employer, MGH embraces diverse skills and perspectives in its hiring process. All qualified applicants will...Daily paid
- Mass Digital Health is seeking a Clinical Reviewer LPN for a work-from-home position. The role involves performing retrospective medical reviews based on patient eligibility and contract requirements, requiring clinical expertise and knowledge of Medicaid guidelines. Candidates...Remote jobContract workWork from home
- ...Mass Digital Health in Quincy, Massachusetts is seeking a Utilization Review Nurse to evaluate patients for admission appropriateness and coordinate care activities. This role demands collaboration with physicians, care managers, and extensive clinical knowledge to ensure...
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Quincy, MA2 days ago - ...or Clinical Coordinator, the Registered Nurse (RN) provides comprehensive, patient-centered care... ...Expectations For Customer Service, Teamwork, Resource Utilization, And Staff And Self Development As Outlined In Performance Review. # Performs Other Duties As Assigned Or...Shift work
Yale New Haven Health
Boston, MA21 hours ago - Blue Cross Blue Shield of Massachusetts in Hingham seeks a Manager, Clinical Review to direct a utilization review clinical team across pre-service, concurrent, and retrospective reviews, ensuring medically necessary, high-quality, cost-effective care. The role emphasizes...
- ...Brigham Incorporated is looking for a Senior Nurse Reviewer responsible for coordinating clinical charge audits and appeal processes. The role demands strong analytical... ...possess a Bachelor's Degree in Nursing, an MA State RN License, and have experience in appeal writing....Remote job
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Yale New Haven Health
Cambridge, MA21 hours ago $95 - $96 per hour
...Radiology you will be a key member of the utilization management team. We can offer you a... ...Be Doing: Serve as the Physician match reviewer in Imaging cases, that do not initially... ...clinical rationale for standard and expedited appeals. Utilizes medical/clinical review...Full timePart timeWork at officeImmediate startEvolent
Boston, MA21 hours ago$124.8k - $156k
...independently with limited supervision, coaching and reviewing the work of lower level professionals, resolving... ...This Physician Assistant – The PA will support NAVIGATE workflows to reduce acute ED and inpatient utilization. Primary Care position is responsible, within the...Work experience placement- ...Saint Raphael Campus Medicine MICU / SDU RN Pathway Designed for Medicine RNs interested in... ...expectations for customer service, teamwork, resource utilization, and staff and self development as outlined in performance review. # Performs other duties as assigned or...
Yale New Haven Health
Boston, MA21 hours ago
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