- Commonwealth Care Alliance (Boston, MA)
- …Reporting to the Director of Health Information Management, the Senior HIM Specialist is responsible for following processes to ensure compliant validation and entry ... released by CCA for tracking and metrics. - Obtain documentation from outside EMRs in preparation of HEDIS review,...and consistently in CCAs electronic medical record. - Support clinical teams by obtaining medical record requests in a… more
- Commonwealth Care Alliance (Boston, MA)
- 023680 Clin Alli-Onboarding & Scheduling **Position Summary** The Onboarding Specialist is the primary contact for members as they transition to a CCA health plan. ... The Specialist contacts new members via telephonic outreach and identifies...provider outreach and education + Schedules new members' initial nurse intake visits + Utilizes communication skills such as… more
- Commonwealth Care Alliance (Boston, MA)
- …needs, goals, and preferences. The Community Health Worker is knowledgeable of clinical care, health systems, and social drivers of health, and ensures that ... and social needs. + CHWs ensure appropriate, comprehensive, and timely documentation of all contacts, outreaches, assessments, and interventions in the Centralized… more
- Commonwealth Care Alliance (Boston, MA)
- …provider community. In this highly visible field position, the provider relations specialist acts as the primary liaison between CCA and its providers including ... policies related to: Claims and service recovery; Program benefits; Clinical initiatives; Referral and authorization; Regulatory compliance; Billing and payments;… more
- Commonwealth Care Alliance (Boston, MA)
- …Engagement & Performance **Position Summary:** The Senior Provider Relations Specialist is responsible for building, maintaining and strengthening relationships with ... Excellence:** + Collaborate with cross-functional teams (eg, Claims, Credentialing, Clinical Care Management, Member Services, Provider Services, Regulatory Affairs,… more
- Beth Israel Lahey Health (Boston, MA)
- …a difference in people's lives.** The Clinical Documentation Improvement (CDI) Specialist Registered Nurse ( RN ) assists with the appropriate ... Risk of Morality (ROM), during an inpatient hospitalization. CDI Specialist RN initiates concurrent queries to providers...of acute care clinical experience. + Certified Clinical Documentation Specialist (CCDS) or… more
- Beth Israel Lahey Health (Burlington, MA)
- …of Coding & Clinical Documentation oversees a highly trained Clinical Documentation Specialist (CDS) team, working collaboratively with providers and ... compliance, and performance across all assigned facilities. The Manager, Coding & Clinical Documentation coordinates the Clinical Documentation … more
- Cognizant (Boston, MA)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...the Health Plan/Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid,… more
- Tufts Medicine (Boston, MA)
- …**:** 1. Associate's Degree in Nursing. 2. Basic Life Support (BLS) Certification. 3. Registered Nurse ( RN ) License. 4. Three (3) years of Case ... In addition, this role focuses on performing the following Clinical Nurse duties: Assesses, plans, implements, and...payor requirements to perform job responsibilities. 17. Works with documentation specialist to have accurate length of… more
- Molina Healthcare (Norfolk, MA)
- … quality investigations, preferably in a managed care setting, or equivalent experience * Registered Nurse . License must be active and unrestricted in state of ... JOB DESCRIPTION Job Summary Provides senior level clinical support to quality team - contributing to...care and critical incident cases; review of medical record documentation for credentialing and model of care oversight; and… more
- Sedgwick (Boston, MA)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Disability Clinical Specialist **PRIMARY PURPOSE** : Performs standard clinical ... rationale. + Completes medical review of all claims by reviewing medical documentation received and applying practical clinical knowledge to ensure information… more
- Dana-Farber Cancer Institute (Boston, MA)
- …network with other nursing informatics professionals. + Other duties as assigned. + Registered nurse with 3 years of experience in healthcare required, oncology ... The Nursing Informatics Specialist is a member of the Nursing and...and Epic Operations teams and is responsible to ensure clinical information system implementations are consistent with Dana-Farber Cancer… more
- Molina Healthcare (Norfolk, MA)
- **Job Description** **Job Summary** The Specialist , Member & Community Interventions implements new and existing clinical quality member intervention initiatives ... of department interventions + Creates, manages, and/or compiles the required documentation to maintain critical program milestones, deadlines, and/or deliverables +… more
- Commonwealth Care Alliance (Boston, MA)
- …Reporting to the Director of Health Information Management, the Senior HIM Specialist is responsible for following processes to ensure compliant validation and entry ... released by CCA for tracking and metrics. * Obtain documentation from outside EMRs in preparation of HEDIS review,...and consistently in CCAs electronic medical record. * Support clinical teams by obtaining medical record requests in a… more
- Commonwealth Care Alliance (Boston, MA)
- …Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and necessary coding configuration requirements ... Responsibilities:** + Develop enhanced, customized prospective claims auditing and clinical coding and reimbursement policies and necessary coding configuration… more
- Beth Israel Lahey Health (Burlington, MA)
- …designated supervisor (depending on the location) and in collaboration with a clinical overseer, where applicable, the Medical Assistant is responsible for assisting ... in the delivery of high quality and safe clinical care. S/he will assist with patient care and...patient Cares for patients as delegated by the provider, RN or LPN within scope of practice and competence.… more
- Cambridge Health Alliance (Cambridge, MA)
- …Massachusetts licensure authorizing practice in an expanded role as a Psychiatric Nurse Clinical Specialist and authorization including prescriptive ... Practitioner - PACE **Requisition Number:** CHAP-2288 **CHA Psychiatric Mental Health Nurse Practitioner - PACE ( Clinical Specialist II)** **Cambridge… more
