Utilization Review Specialist jobs in Boston, MA

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Utilization Review/Denial Specialist RN
CMS Regulations, Utilization Review criteria. Collect and trend Utilization Review data metrics. 3 -5 years of experience in acute care Utilization Review and...
Care Partner, Team Lead
Commonwealth Care Alliance - 53 reviews - Charlestown, MA 02129
• Leads all team meetings and high risk case reviews. Reviews clinical documentation and records to ensure accuracy and timeliness....
Telephonic RN Care Partner
Commonwealth Care Alliance - 53 reviews - Charlestown, MA 02129
Participates in utilization and case review as necessary. Manages panel-wide and member-specific utilization trends....
NP Care Partner/Mobile
Commonwealth Care Alliance - 53 reviews - Charlestown, MA 02129
Participate in utilization and case review as necessary. Participate in Team Case Review. Liaise with CCA and community based PCPs/ Specialists, as needed....

Payment Verification Specialist

Tufts Medical Center - 244 reviews - Boston, MA
Regular interaction with other departments of the hospital to resolve accounts, including Medical Records, HIM, internal staff members, Utilization Review and...

Health Care Facility Specialist II - South Region

Commonwealth of Massachusetts - 322 reviews - Boston, MA
$60,096 - $87,045 a year
Performs patient centered reviews of Medicare and Medicaid recipients to assess the quality and appropriateness of care rendered in such facilities and to...

Case Management Resource Specialist

Massachusetts General Hospital(MGH) - 761 reviews - Boston, MA
Assuming all administrative responsibilities within the Discharge Planning and Utilization Review processes. Communicates clinical information provided by Case...

Third Party Accounts Receivable Specialist

Tufts Medical Center - 244 reviews - Boston, MA
Regular interaction with other departments of the hospital using electronic system tools to resolve accounts, including Medical Records, Physician's Offices,...

Clinical Documentation Specialist 1199SEIU Union 40 hours

Boston Medical Center (BMC) - 412 reviews - Boston, MA 02118 (South Boston area)
The Clinical Documentation Specialist (CDS) will provide clinically based concurrent and retrospective review of inpatient medical records to evaluate the...

Project Manager

Commonwealth of Massachusetts - 322 reviews - Boston, MA
$60,096 - $87,045 a year
Conducts reviews of independently-managed projects and participates in management reviews as requested. Reviews and approves LHA Capital Improvement Plans (CIPs...

Telephonic Behavioral Health Specialist

Commonwealth Care Alliance - 53 reviews - Charlestown, MA 02129 (Fenway-Kenmore area)
Participates in utilization and case review as necessary. Manages panel-wide and member-specific utilization trends....

Training Specialist - Boston

Commonwealth of Massachusetts - 322 reviews - Boston, MA
$55,017 - $78,763 a year
Review, Overview, Presentation, Exercise and Summary. We are seeking qualified applicants for the position of Training Specialist....

Utilization and Appeal Specialist

Beth Israel Deaconess Hospital-Milton - Milton, MA
Performs pre-admission review for Level of Care determination. Reviews and determines appropriate strategy in response to denials of reimbursement....

Property Data Specialist

Draper - 13 reviews - Cambridge, MA
Accurately maintain Government property records, with regard to acquisition, receiving, identification, movement, storage, inventories, consumption, utilization...
Behavioral Health Care Partner
Participates in utilization and case review as necessary. Manages panel-wide and member-specific utilization trends....
Telephonic Behavioral Health Specialist
Commonwealth Care Alliance - 53 reviews - Charlestown, MA 02129
Participates in utilization and case review as necessary. Manages panel-wide and member-specific utilization trends....
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