Clinical Denials and Appeals Specialist

Role SummaryThe Medical Director for Appeals and Grievances will lead the clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. This role requires a strong clinical background and excellent communication skills to effectively collaborate with medical directors and other stakeholders.Key...

Job SummaryThe Medical Director for Appeals and Grievances will be responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies.Key ResponsibilitiesPerform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO,...

Job Title: Clinical Care SpecialistAbout Us: Visiting Rehab and Nursing Services is a clinician-owned home healthcare agency that prioritizes a strong work-life balance and provides ongoing support to its clinicians. We offer a unique opportunity to work with the ABI waiver program, which allows for consistent scheduling and flexibility in traditional home...

About UsAt Partners HealthCare, we're committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. As a not-for-profit organization, we're dedicated to creating a culture that empowers our managers to become trusted mentors and supports each member of our team to own their personal...

Job Title: MA - Registered Nurse Care CoordinatorJob Summary:We are seeking a highly skilled and experienced Registered Nurse to join our team as a Care Coordinator. The successful candidate will be responsible for providing clinical information to payers, monitoring length of stay, and utilizing the InterQual Program to ensure efficient and cost-effective...

Job SummaryAs a Clinical Support Specialist at Brigham and Women's Hospital, you will play a vital role in ensuring the smooth operation of our medical office. Your primary responsibility will be to provide administrative support to our healthcare team, handling tasks such as scheduling appointments, managing patient records, and communicating with patients...

Job SummaryPine Street Inn is seeking a highly skilled Clinical Outreach Specialist to join our team. This role will work within our Specialized Outreach Program – Pathways to Recovery – designed for unsheltered individuals with SUD and COD.The successful candidate will develop an individual community-based assessment with successful connections to...

Job SummaryThe Clinical Development Specialist RN will be responsible for planning, implementing, and evaluating an ongoing program of clinical orientation for assigned staff. This program will be consistent with the goals of Nursing Patient Care Operations, CEI, and Professional Development Council. The specialist will maintain and enhance clinical...

Job Title: RN-Staff: MA - Gardner, MA - Registered Nurse Care Coordinator, Case Management DepartmentJob Summary: We are seeking a highly skilled Registered Nurse to join our Case Management Department as a Care Coordinator. The ideal candidate will have a strong background in nursing, excellent communication skills, and the ability to work effectively in a...

**Clinical Development Specialist**At Boston Children's Hospital, we are seeking a highly skilled Clinical Development Specialist to join our team. The successful candidate will be responsible for planning, implementing, and evaluating an ongoing program of clinical orientation for assigned staff.The ideal candidate will have a strong background in nursing...

Job Title: Clinical Care SpecialistJob Summary:We are seeking a skilled Clinical Care Specialist to join our team at Top Tier Reps LLC. As a Clinical Care Specialist, you will be responsible for providing direct patient care across the healthcare continuum, adhering to Massachusetts Board of Registration in Nursing regulations.Responsibilities:Utilize the...

Job SummaryWe are seeking a highly experienced and strategic leader to join our team as an Associate Vice President of Strategy Advancement. This individual will be responsible for leading our Care Management programs, including predictive models, engagement strategies, and intervention support. They will also oversee Utilization Management, including...

Job SummaryThe Senior Clinical Specialist will provide technical expertise in blood banking and assist in key projects to improve blood bank operations at MGH. The incumbent will work closely with the BTS Medical Director, Laboratory Supervisors, Compliance Officer, Transfusion Safety Officer, and the Blood Bank IT Team.Key ResponsibilitiesProvide technical...

Job Summary:The Clinical Nurse Specialist at Tufts Medicine is responsible for providing professional and nonprofessional nursing care services in accordance with physician orders.This role focuses on assessing, planning, implementing, and evaluating the care needs of a designated group of patients or providing nursing care and identified clinical support...

Job Title: Grounds Maintenance SpecialistAbacus Staffing is seeking a skilled Grounds Maintenance Specialist to join our team. As a Grounds Maintenance Specialist, you will be responsible for maintaining the grounds of our cemetery, ensuring that they are well-manicured and visually appealing.Key Responsibilities:Maintain the grounds of the cemetery,...

Key ResponsibilitiesUnder the general direction of the Technical Supervisor, provides ancillary support for clinical activities by performance and appropriate interpretation of moderate and high complexity clinical laboratory tests as defined under CLIA '88.Required Skills and ExperienceCollege graduate with ASCP certification and prior experience and...

Patient Care with ExcellenceNursing at Brigham and Women's Hospital is renowned for its excellent clinical practice and commitment to patient-centered care. Our team of dedicated professionals is passionate about delivering the highest quality care to patients and their families.We prioritize building strong relationships with our patients, based on trust,...

Job SummaryThe Brigham and Women's Hospital is seeking a skilled Clinical Support Specialist to join our team. As a Clinical Support Specialist, you will be responsible for providing administrative support to clinicians, patients, and families in a fast-paced medical environment.Key ResponsibilitiesAdministrative activities supporting clinicians, patients,...

Job SummaryWe are seeking a highly skilled Clinical Ventilation Specialist to join our team at Nihon Kohden America. As a key member of our sales team, you will be responsible for delivering product demonstrations and managing clinical evaluations of our ventilation systems.Key Responsibilities:Review and achieve a score of 90% on Product Knowledge...

Exercise Specialist OpportunityMarathon Physical Therapy & Sports Medicine is seeking a motivated and passionate Exercise Specialist to join our team. As an Exercise Specialist, you will play a vital role in supporting patients and Physical Therapists to implement personalized exercise programs.Responsibilities:Assist MPT staff during fitness assessments,...