- 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
- Dana-Farber Cancer Institute (Brookline, MA)
- …RI, CT) 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
- 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
- HCA Healthcare (Manchester, NH)
- …services, and play a key role in the integration of HCA Clinical Strategies and HCA systems. **Medical Staff Administration** Develop facility credentialing policies ... (in partnership with other key stakeholders to include Director of Advanced Clinical and IT&S personnel). Facilitate orientation for new officers, committee members… more
- HCA Healthcare (Manchester, NH)
- …staff services, and play a key role in the integration of HCA Clinical Strategies and HCA systems. 1. Medical Staff Administration Develop facility credentialing ... (in partnership with other key stakeholders to include Director of Advanced Clinical and IT&S personnel). Facilitate orientation for new officers, committee members… 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
