Clinical Utilization Specialist
3 weeks ago
As a Utilization Reviewer at McLean Hospital, you will play a critical role in ensuring high-quality medical outcomes for patients who require precertification/preauthorization. This position involves performing concurrent reviews of outpatient and in-patient claims, as well as authorization reviews of patient services.
Key Responsibilities- Assess, review, and assign cases for utilization review (UR)
- Assist with negotiations of access to care in specified targeted areas; maintain relationships with providers who provide services to patients and pursue a responsive system for authorization of services and approved claims
- Prepare clinical information for each concurrent review directly from the medical record
- Protect healthcare organization value by keeping information confidential; cautioning others regarding potential breaches
- Facilitate effective communication between members of the treatment team
- Maintain compliance with regulation changes affecting utilization management
- Use appropriate screening criteria, knowledge, and clinical judgment to assess patient needs
- Recognize and report appropriately cases of fraud, abuse, or mis-utilization
- Ensure quality and quantity of documentation in medical records for UR
- Education: Social work, Nursing, Licensed mental health counselor
- Licenses and Certifications: Social Worker, Licensed Clinical LCSW - State License preferred; Registered Nurse RN - State License preferred; Licensed Mental Health Counselor State License preferred
- Work Experience: Clinical experience, including during training, working with Rehab, psychiatric in-patient population
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Subsurface Utility Engineering Specialist
2 weeks ago
Boston, Massachusetts, United States T2 Utility Engineers Full timeJob Title: Subsurface Utility Engineering SpecialistAre you a skilled utility locator looking for a challenging role in a dynamic company? T2 Utility Engineers is seeking a highly motivated and experienced Subsurface Utility Engineering Specialist to join our team in Boston, MA.Job Summary:We are looking for a skilled and experienced Subsurface Utility...
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Clinical Denials and Appeals Specialist
4 days ago
Boston, Massachusetts, United States Boston Medical Center Full timePOSITION SUMMARY:The Clinical Denials and Appeals Specialist at Boston Medical Center assesses, plans, coordinates, and evaluates initial and ongoing denials. This role requires a comprehensive understanding of clinical documentation and medical coding, as well as a working knowledge of patient financial billing regulations and requirements. The Specialist...
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Clinical Care Specialist
4 days ago
Boston, Massachusetts, United States Top Tier Reps LLC Full timeJob 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...
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Clinical Nurse Specialist
1 month ago
Boston, Massachusetts, United States Tufts Medical Center Full timeJob OverviewThe Clinical Nurse Specialist at Tufts Medical Center is a senior-level role that requires advanced knowledge of job area typically obtained through advanced education and work experience. This position is responsible for providing professional nursing care to patients, managing projects/processes, working independently with limited supervision,...
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Utilities Control Billing Specialist
2 weeks ago
Boston, Massachusetts, United States Massachusetts Port Authority Full timeAbout UsThe Massachusetts Port Authority is a dynamic organization that connects people and businesses to the global community by air, land, and sea. Our employees are essential in moving planes, cargo, and cruise ships safely, efficiently, and sustainably. We are an economic engine, managing real estate assets where people live, work, and play.Job SummaryWe...
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Clinical Outreach Specialist
1 week ago
Boston, Massachusetts, United States Pine Street Inn Full timeJob 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...
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Clinical Development Specialist
4 days ago
Boston, Massachusetts, United States Boston Children's Hospital Full timeJob 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...
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Clinical Oversight Specialist
2 months ago
Boston, Massachusetts, United States Mightier Full timeJob DescriptionCompany OverviewMightier is a leading provider of digital mental health solutions for children and families. Our mission is to empower every child to be their best self by providing access to evidence-based, clinically-proven programs that promote healthy coping skills and emotional regulation.Job SummaryWe are seeking a highly skilled and...
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Utilities Control Billing Specialist
4 days ago
Boston, Massachusetts, United States Massachusetts Port Authority Full timeAbout the Role:As a Utilities Control Billing Specialist at the Massachusetts Port Authority, you will play a crucial role in managing utility data, ensuring accuracy and compliance in billing and record-keeping. Your strong analytical skills will help identify patterns and trends, while your organizational prowess will manage multiple tasks seamlessly. You...
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Clinical Development Specialist
2 weeks ago
Boston, Massachusetts, United States Boston Children's Hospital Full timeClinical Development Specialist **Job Summary** Boston Children's Hospital is seeking a skilled Clinical Development Specialist to join our team. As a key member of our Nursing Patient Care Operations, you will be responsible for planning, implementing, and evaluating an ongoing program of clinical orientation for assigned staff. Your expertise will ensure...
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Clinical Nurse Specialist
3 weeks ago
Boston, Massachusetts, United States Tufts Medicine Full timeJob Title: Clinical Nurse SpecialistAt Tufts Medicine, we are seeking a highly skilled Clinical Nurse Specialist to join our team. As a Clinical Nurse Specialist, you will be responsible for providing expert nursing care to patients and families, while also educating and mentoring nursing staff.Key Responsibilities:Assess and plan care for patients with...
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Clinical Nurse Specialist
3 weeks ago
Boston, Massachusetts, United States Tufts Medicine Full timeJob Title: Clinical Nurse SpecialistAt Tufts Medicine, we are seeking a highly skilled Clinical Nurse Specialist to join our team. As a Clinical Nurse Specialist, you will be responsible for providing high-quality patient care and leading the development of nursing practice.Key Responsibilities:Assess, plan, implement, and evaluate patient care to achieve...
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Clinical Specialist, CRM
1 month ago
Boston, Massachusetts, United States Abbott Full timeJob SummaryAbbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines.We are seeking a highly skilled Clinical Specialist to join our...
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Boston, Massachusetts, United States Children's Hospital Boston Full timeWe are seeking a highly skilled Technical Support Specialist for Clinical Applications to join our team at Boston Children\u0027s Hospital. This is a fully onsite position in the OR environment, providing support for hardware and software utilized in clinical care.The schedule usually consists of four 10-hour workdays, with the requirement to rotate days of...
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Clinical Development Specialist
1 week ago
Boston, Massachusetts, United States Boston Children's Hospital Full time**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...
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Clinical Care Specialist
4 days ago
Boston, Massachusetts, United States Visiting Rehab and Nursing Services Full timeJob 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...
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Senior Clinical Specialist
4 weeks ago
Boston, Massachusetts, United States Puma Biotechnology Inc Full timePuma Biotechnology Inc. Job DescriptionJob Title: Senior Clinical SpecialistLocation: Boston, MA; Portland, ME; Manchester, NH; Newbury, MAJob SummaryWe are seeking a highly motivated and results-driven Senior Clinical Specialist to join our team at Puma Biotechnology Inc. The ideal candidate will have a strong background in oncology sales and a proven track...
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Senior Clinical Specialist
1 week ago
Boston, Massachusetts, United States Massachusetts General Hospital(MGH) Full timeJob 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...
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Clinical Nurse Specialist
4 days ago
Boston, Massachusetts, United States Tufts Medicine Full timeJob 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...
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Clinical Social Worker MSW Specialist
3 weeks ago
Boston, Massachusetts, United States Children's Hospital Boston Full time{"title": "Clinical Social Worker MSW", "description": "Job SummaryWe are seeking a highly skilled Clinical Social Worker MSW to join our team in the Emergency Department at Children\u2019s Hospital Boston. The successful candidate will provide clinical social work services to patients and families, working collaboratively with the interdisciplinary team to...