- Harbor Health Services, Inc. (Mattapan, MA)
- …in quality and consistency of decisions. Supervisory responsibilities for UM RN , Quality Analyst, Appeals and Grievances Specialist . Requirements: Bachelor's ... with all contract requirements, as well as state and federal regulatory requirements; maintains audit-ready status. Creates a continuous learning culture and… more
- Commonwealth Care Alliance (Boston, MA)
- …Excellence:** + Collaborate with cross-functional teams (eg, Claims, Credentialing, Clinical Care Management, Member Services, Provider Services, Regulatory ... potential recruitment opportunities + Coordinate with other CCA departments, including Clinical Management, Member Services, Claims, Regulatory Affairs, Outreach… more
- Commonwealth Care Alliance (Boston, MA)
- …on CCA's policies related to: Claims and service recovery; Program benefits; Clinical initiatives; Referral and authorization; Regulatory compliance; Billing and ... potential recruitment opportunities. + Coordinate with other CCA departments, including Clinical Management, Member Services, Regulatory Affairs, Claims and… more
- Dana-Farber Cancer Institute (Boston, MA)
- …+ Master of Science in Nursing required; Clinical Nurse Specialist track is preferred. + Current RN license in Massachusetts (compact licensure) ... the quality of patient care, and maintain compliance with regulatory standards. Clinical Practice Specialist ...Oncology Nursing Society (ONS) and the National Association of Clinical Nurse Specialists. The mission, vision, and… more
- Tufts Medicine (Melrose, MA)
- …requesting an out-of-area referral. **Job Description** **Minimum Qualifications:** 1. Massachusetts RN Licensure. 2. Five (5) years of experience in acute hospital ... list. Other duties and responsibilities may be assigned. 1.Collaborates with PHO clinical leadership and conduct root cause analysis to identify rising and… more
- Beth Israel Lahey Health (Cambridge, MA)
- …to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by ... on the key performance indicators and quality measures, the RN specialist also aims to foster a...reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review… more
- Beth Israel Lahey Health (Burlington, MA)
- …Master's degree in nursing preferred Licensure, Certification & Registration: Valid Registered Nurse licensure within the state of Massachusetts required ... of assigned studies so as to serve as a specialist for the assigned research study and triage calls.../ Supervisor receives general oversight; support of research initiatives, regulatory guidance 3 . Sr. Clinical Research… more
- Deloitte (Boston, MA)
- …medical degree, or physician assistant required + Current Registered Nurse ( RN ) license required + Certified Clinical Documentation Specialist - CCDS ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory...CCA, CCS-P, CCS, CPC, CDIP, CCM) + Experience as clinical registered nurse , physician, physician… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …integral part of the Credentialing & Peer Review (CPR) Team, the Peer Review Specialist works closely with CPR's Director and Clinical Lead, Operations Lead, ... your true colors to blue. The Role:The Peer Review Specialist is responsible for monitoring the quality of the...Physician Review Units + Prepare documentation in response to regulatory inquiries (eg, subpoena, regulatory filings, CMS… more
- Dana-Farber Cancer Institute (Boston, MA)
- …network with other nursing informatics professionals. + Other duties as assigned. + Registered nurse with 3 years of experience in healthcare required, oncology ... The Nursing Informatics Specialist is a member of the Nursing and...knowledge to the DFCI and BCH Epic team regarding clinical , regulatory and/or operational needs as part… more
