- Dana-Farber Cancer Institute (Brookline, MA)
- Under the general supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to ... conducting a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling arguments based on … more
- Cognizant (Boston, MA)
- …cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... help you stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is a plus. We're excited to meet people… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve ... plans. Reporting to the Prior Authorization Supervisor , the Clinical Authorization Specialist is responsible for managing...+ Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label… more
- Beth Israel Lahey Health (Cambridge, MA)
- …skills to prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer review. ... & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality...knowledge of disease and nursing processes to write effective appeals and clinical abstracts, identifies quality of… more
- Evolent (Boston, MA)
- …guidance and expertise to ensure the application of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations ... Are you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular… more
- State of Massachusetts (Waltham, MA)
- …Eligibility Psychologist to join our Metro Regional Office. This role will provide clinical assessment and evaluation at the request of the Regional Director or ... determinations, competency evaluations, emergency case reviews and other specialized clinical assessments and evaluations. The Intake and Eligibility Psychologist… more
- Tufts Medicine (Melrose, MA)
- …of upcoming prescription refills and informs them of prior authorizations or appeals process. 7. Refers patients' concerns requiring clinical interpretation to ... or a role that focuses on support of daily business activities (eg, technical, clinical , non- clinical ) operating in a "hands on" environment. The majority of… more