- US Tech Solutions (Canton, MA)
- …required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that is expected to function independently in her / ... complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical...the job** + Bachelor's degree in Nursing, preferred + Registered Nurse with current a and unrestricted… more
- Actalent (Boston, MA)
- Clinical Review Clinician Job Description As a Clinical Review Clinician specializing in appeals, you will be responsible for preparing case reviews for ... the basis for each appeal. You will ensure timely review , processing, and response to appeals in accordance with...processes is preferred. + State Licensure as LPN, LVN, RN , LCSW, LMHC, LPC, Licensed Marital and Family Therapist,… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** The Sr Clinician , Behavioral Health Utilization Review will review behavioral health and substance ... with transition of care planning and coordination when a Commonwealth Care Alliance clinician is not already involved. Work with ESPs to ensure appropriate and… more
- Commonwealth Care Alliance (Boston, MA)
- …outreach to patients to explain services and schedule initial visits for the assigned clinician . The RN in this role will also be reviewing Algorithm Identified ... Referrals, Health Plan Referrals and Palliative Smart List to review CCA Health Plan members identified with Care Delivery...same with the member or healthcare surrogate and assign clinician in coordination with clinician 's supervisor. *… more
- Aveanna Healthcare (Brockton, MA)
- …the way homecare is delivered, one patient at a time. This is a fantastic opportunity for a talented nurse looking to expand their career, truly increasing the ... per year Position Details Aveanna Healthcare is hiring a Nurse Supervisor in your area! Make a difference every...the Nursing Supervisor: + Must have good standing license ( RN ) in the state in which the clinician… more
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for ... membership. The incumbent will have significant experience with utilization review , ideally experience with public programming, and excellent clinical judgment.… more
- Commonwealth Care Alliance (Boston, MA)
- …CCA-Clin Informatics & Sys Dev **Position Summary** The Clinical Informaticist is a Registered Nurse , clinician or individual experienced in working in ... to our members/patients, and (3) the efficiency and efficacy of clinical operations , direct care, and care management activities. This role proactively creates… more
- Beth Israel Lahey Health (Boston, MA)
- …a different clinic. Working in the Ambulatory Float Pool is an excellent opportunity to gain experience in a variety of Ambulatory specialties while enhancing ... administrative and clinical functions to support smooth and efficient practice operations , while contributing to BIDMC's promise of providing extraordinary care.… more