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Utilization Review Jobs in Boston

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Search Results - Utilization Review Jobs in Boston
Boston Medical Center (BMC)-Boston
Position Summary The RN Appeal Administrator will be responsible for the Pre-denial/ Denial and appeal process in addition to Utilization Review, to validate the patient’s placement to be at the most appropriate level of care based on nationally...
Northeast Healthcare Recruitment, Inc. (NEHCR)-Boston
medication; assumes leadership role in case conferences and in-service training of staff; actively participates in peer review and Utilization Review (UR). Responsibilities:  •  Prescribes and maintains clients on psychotropic medication.  •  Evaluation...
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Boston Medical Center (BMC)-Boston
served. This role is responsible for ensuring consistencies in the standard of practice across clinical settings and will provide quality management, risk management, and utilization review as required. The incumbent will work cooperatively...
Encompass Health-Boston
and payor-related information in the patient record.  •  Participate in utilization review process: data collection, trend review, and resolution actions.  •  Participate in case management on-call schedule as needed. Qualifications  •  License or Certification...
USI Insurance Services-Boston
treatment guidelines and determinations.  •  Act as a medical resource in regard to utilization review to claims support nurse and claims department.  •  Foster a positive and close working relationship with company staff, including claims staff, medical bill...
Encompass Health-Boston
documentation to post discharge providers/physicians.  •  Ensure accuracy of discharge and payor-related information in the patient record.  •  Participate in utilization review process: data collection, trend review, and resolution actions.  •  Participate in case...
Encompass Health-Boston
appropriate/timely referrals, including documentation to post discharge providers/physicians.  •  Ensure accuracy of discharge and payor-related information in the patient record.  •  Participate in utilization review process: data collection, trend review...
Leading Age-Boston
the company’s clinical decision guidelines and evidence based literature  •  Provide expert input on content for influencing physicians in medical care to improve the quality of patient outcomes  •  Provide timely medical reviews that meet Cohere’s stringent quality...
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Telligen-Boston
Medicine.   3.  3 years of experience working with Medicaid-specific utilization review and quality improvement.   4.  The Medical Director may not serve in any role in a hospital setting while employed with Telligen.   5.  Because of the nature and immediacy...
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Leading Age-Boston
/fellowship in Internal Medicine or Cardiology  •  1+ years of managed care utilization review experience desirable  •  Membership in national and/or regional specialty societies  •  Licensure in AZ, GA, MS, NC, ND, OK, OR, or TX is highly desirable - you should...
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