- 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)
- …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
- 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
- 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
- Brockton Hospital (Brockton, MA)
- …from Commonwealth of Massachusetts to practice as a Registered Nurse Experience: Minimum of five years clinical experience required. Software/Hardware: ... electronic health record required + Ability to evaluate the quality of clinical documentation to spot incomplete or inconsistent documentation for in-patient… 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
- 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
- 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)
- …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
