2374 Rn jobs in Melrose,MA

RN

Emerson Health

Concord, MA 01742

Carle Health

Melrose, MA

HealthX Ventures

Melrose, MA

Johns Hopkins Hospital

Melrose, MA

Yale New Haven Hospital

Boston, MA 02108

Fairlawn Rehabilitation Hospital

Boston, MA 02298

Tufts Medical Center

Boston, MA 02298

Cohere Health

Melrose, MA

US Tech Solutions

Melrose, MA

UnitedHealth Group

Boston, MA 02112

Registered Nurse (RN) with a current, active, unrestricted RN License in Massachusetts
Currently have OR be able to obtain an RAC/CT MDS certification (must have completed certification prior to start date)
4+ years of nursing experience, specifically in long-term care and/or medical record review with knowledge of Medicare and Medicaid
Recent long-term care MMQ, MDS, staff development or management experience (in long-term care)
Experience working within medical insurance and/or healthcare industries
Experience analyzing inventory, researching, identifying, and resolving issues
Experience with defining and managing processes within a team
Experience trouble shooting issues for users within teams, IT, and/or business partners
Proven knowledge of healthcare insurance industry (Medicaid, Medicare, CMS)
Demonstrated knowledge of process flow of UM, including prior authorization, concurrent authorization, and/or clinical appeal and guidance reviews
Must live in the Boston MA Regional Area to conduct daily travel requirements
Ability to travel within geographic territory (state of Massachusetts) at least 90% of the time (some weeks will require 100% travel as business needs dictate) and assist when needed throughout the state of Massachusetts for audits. (Audits will be conducted onsite)
Must have reliable transportation and be able to provide proof of a valid, unrestricted Driver's License and current Auto Insurance