- Actalent (Boston, MA)
- Clinical Review Clinician Job Description As a Clinical Review Clinician specializing in appeals , you will be responsible for preparing case ... to appeals requests. + Partner with interdepartmental teams to improve clinical appeals processes and procedures, preventing recurrences based on industry… more
- Commonwealth Care Alliance (Boston, MA)
- …utilization review , ideally experience with public programming, and excellent clinical judgment. They will work well both independently and in conjunction with ... & Responsibilities:** + Primary responsibility for performing daily medical reviews, appeals as appropriate, correspondence regarding review determinations and… more
- Humana (Providence, RI)
- …**Key Responsibilities** **:** + Lead an operational team of Medical Directors to review authorizations and ensure clinical decision-making skills that align to ... key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus on our 5+ million… more