- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas of BCBSMA. The ... your true colors to blue. The Role The Physician Reviewer is responsible for evaluating clinical service...anticipatory case management for members whose cases come for review , in partnership with case managers + Participate in… more
- Evolent (Boston, MA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …gather clinical information to support the plan of care. + Monitor clinical quality concerns, make referrals appropriately, identify and escalate quality ... use of the member's benefit to provide the best quality care. The TeamThe RN Utilization Management Reviewer...with emphasis on utilization management, discharge planning, care coordination, clinical outcomes, and quality of service. +… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** **This position is remote . Candidates must be local to New England States for consideration** The ... Clinical Documentation Improvement (CDI) Specialist Registered Nurse (RN) assists...medical record documentation to improve the accuracy, integrity, and quality of patient data, and drive improvement toward … more
- Beth Israel Lahey Health (Charlestown, MA)
- …taking a job, you're making a difference in people's lives.** **This position is remote . Candidates must be local to New England States for consideration** The ... Clinical Documentation Improvement (CDI) Specialist II assists with the...medical record documentation to improve the accuracy, integrity, and quality of patient data, and drive improvement toward … more
- Prime Therapeutics (Boston, MA)
- …build the future of pharmacy with us. **Job Posting Title** Georgia Medicaid Clinical Account Manager - Remote **Job Description** Innovative business clinician ... visa or residency sponsorship **Additional Qualifications** + 3-5 years' experience in clinical operations, quality , network, pharmacy or project management OR a… more
- Evolent (Boston, MA)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... clinical professionals. + A role that values innovation, continuous improvement, and clinical excellence. + **This position is 100% Remote and can be… more
- Takeda Pharmaceuticals (Boston, MA)
- …the best of my knowledge. **Job Description** **About the role:** The Associate Director, Clinical & Quality Process Compliance is responsible for ensuring the ... teams for regulations impacting Clinical , Safety and Clinical Pharmacovigilance Medical Quality (CPMQ) processes and...trial delivery in partnership with GDO, PSPV, GRA etc. Review the outputs of the safety and clinical… more
- Fallon Health (Worcester, MA)
- …among the nation's top health plans for member experience, service, and clinical quality . We believe our individual differences, life experiences, knowledge, ... relevant clinical information from medical care providers as needed for the clinical review process * Conducts pre-authorization and concurrent clinical … more
- Parexel (Boston, MA)
- … Study Protocol (CSP) or ICH-GCP compliance issues to Local Management and/or Clinical Quality Management (CQM) as required. + Assists site in maintaining ... **CRA and Sr CRA positions- Remote - Need for SE Region - FL**...audits and regulatory inspections in liaison with LSAD and Clinical Quality Associate Director (CQAD). + Ensures… more