Top 2789 Clinician Jobs in Melrose Ma

Prior Authorization Clinician - Home Care
Daley and Associates —Charlestown, MA
- $50 - $53 an hour
- Weekends as needed
- Nursing
- RN License
- Mid-level
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4d
Licensed Therapist
UnitedHealth Group —Burlington, MA
- $69,100 - $103,800 a year
- Full-time
- LMFT
- Microsoft Outlook
- Pass drug screening
- Continuing education credits
- Health insurance
RN, Home Care
Mass General Brigham Home Care, Inc. —Newton, MA
- $40.09 - $71.12 an hour
- Full-time
- Hybrid work
- RN License
- Mid-level
- Travel
- Health insurance
- Dental insurance
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Mohs Surgical Assistant (20 hours)
APDerm —Stoneham, MA
- $24.50 - $36.75 an hour
- Part-time
- Vital signs
- Surgery
- Medical office experience
- Paid time off
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11d
School Registered Nurse (RN)
Aveanna Healthcare —Arlington, MA
- $54 - $56 an hour
- Part-time
- CPR Certification
- RN License
- BLS Certification
- Paid training
- Employee stock purchase plan
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Clinical Documentation Specialist II- RN- Remote
Beth Israel Lahey Health —Charlestown, MA
- $102,000 - $158,392 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
CARE Clinician
City of Cambridge, MA —Cambridge, MA
- $93,301 - $117,882 a year
- Nights as needed
- Background check
- LMFT
- Master of Social Work
Student Assistance Program ACRA Clinician, Gloucester
Beth Israel Lahey Health —Beverly, MA
- $68,993 - $95,368 a year
- Full-time
- Classroom
- Mid-level
- Master's degree
School- Based Behavior Technician (BT)
Community Autism Services —Malden, MA
- $24 - $32 an hour
- Full-time
- Classroom
- 18 years or older
- High school diploma or GED
- Paid training
- Tuition reimbursement
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14d
Mental Health Clinician and Group Facilitator for Teens and Parents
Adolescent Consultation Services —Cambridge, MA
- $75,000 - $85,000 a year
- Full-time
- Spanish
- English
- Mid-level
- Continuing education credits
- 403(b) matching
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Senior Licensed Clinician
Spectrum Health Systems —Framingham, MA
- $74,000 - $85,664 a year
- Full-time
- Nursing
- Management
- Addiction Medicine
- Loan repayment program
- Health insurance
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Licensed Clinical Supervisor
Confidential —Andover, MA
- $80,000 a year
- 8 hour shift
- Background check
- Psychiatry
- Mid-level
- Health savings account
- Health insurance
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Physical Therapist Outpatient Ortho & Sports | PT-Owned Practice | Westford
Pro Sports Therapy, Inc —Westford, MA
- $80,000 - $110,000 a year
- Full-time
- Private practice
- CPR Certification
- Physical & Rehabilitation Medicine
- Continuing education credits
- Disability insurance
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Physical Therapist — Quality Care, 12 Patients/Day
Rebound Physical Therapy —Natick, MA
- $85,000 - $105,000 a year
- Full-time
- Physical & Rehabilitation Medicine
- Outpatient experience
- Clinic
- Continuing education credits
- Disability insurance
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1d
Physical Therapist
Professional Physical Therapy —Arlington, MA
- $90,000 - $100,000 a year
- Full-time
- Physical & Rehabilitation Medicine
- Mid-level
- Outpatient experience
- Continuing education credits
- Health insurance
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Pediatric Occupational Therapist
Meeting Milestones Children's Therapies —Ipswich, MA
- $75 an hour
- Part-time
- Experience working with children
- Children
- Pediatrics
- Flexible schedule
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Physical Therapist
Stern at Home Therapy —Braintree, MA
- $62 - $75 an hour
- Part-time
- Doctoral degree
- Physical & Rehabilitation Medicine
- Mid-level
- Continuing education credits
- Paid holidays
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8d
Physical Therapist - $15,000 Welcome Bonus
ATI Physical Therapy —Natick, MA
- $85,000 - $106,000 a year
- Full-time
- Physical & Rehabilitation Medicine
- Mid-level
- Outpatient experience
- Continuing education credits
- Paid holidays
Physical Therapist – Orthopedic Outpatient | No Productivity Quotas | Clinical Autonomy
HD Physical Therapy —Wakefield, MA
- $85,000 - $105,000 a year
- Full-time
- Physical & Rehabilitation Medicine
- 11+ years
- Mid-level
- Continuing education credits
- Disability insurance
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Crisis Clinician - Boston CBHC AMCI
Bay Cove Human Services —Boston, MA
- $31.87 - $35.31 an hour
- Weekends as needed
- Bilingual
- Management
- Adults
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clinician jobs near melrose ma

Prior Authorization Clinician - Home Care

Daley and Associates -
Charlestown, MA

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Job Details

Contract
$50 - $53 an hour
4 days ago

Qualifications

Home care experience
Home health care assistance
RN License
Outpatient experience
Outpatient facility experience
Pre-authorization review for utilization management
Clinical documentation
Home health agency experience

Full Job Description

Prior Authorization Clinician - Home Care

Our client, a nonprofit managed care organization affiliated with a major academic healthcare system, is seeking a Prior Authorization Clinician to join its utilization management team for a 3-month contract with the potential to extend. This person will be responsible for reviewing home care and home health service requests for medical necessity, appropriate utilization, and benefit coverage.

The ideal candidate will have experience on both sides of home care: direct clinical experience providing care to patients in their homes and payer-side prior authorization experience reviewing home care requests for an insurance company or managed care organization.

Key Responsibilities

Review prior authorization requests for home care and home health services to determine medical necessity, appropriate level of care, and benefit coverage.
Evaluate submitted clinical documentation and apply evidence-based guidelines, including InterQual criteria, medical policies, and benefit requirements.
Complete first-level clinical reviews and approve services that meet established medical-necessity criteria.
Refer cases that do not meet criteria or lack applicable guidelines to a Physician Reviewer in accordance with departmental workflows.
Perform pre-certification, concurrent, and retrospective utilization reviews as assigned.
Document all review activities, clinical findings, communications, and determinations accurately within applicable systems.
Communicate professionally with providers, clinical staff, internal stakeholders, and physician reviewers regarding authorization requests.
Ensure cases are completed within applicable Medicaid, Medicare, ACA, CMS, NCQA, and departmental turnaround times.
Maintain established productivity expectations while consistently meeting quality and audit standards.
Generate and send appropriate determination letters to providers and members.
Identify potential cases for referral to Care Management.
Support and coach other utilization review nurses and assist with the orientation of newly hired team members as needed.
Participate in team meetings, educational activities, quality initiatives, and audit-related activities.
Identify opportunities to improve utilization review workflows, documentation, and communication.
Maintain compliance with all departmental policies and applicable federal, state, and accreditation requirements.

Qualifications

Nursing degree or diploma required; bachelor’s degree in nursing preferred.
Active, unrestricted RN license in the state of residence required.
Appropriate Massachusetts, New Hampshire, or compact-state licensure required.
Direct outpatient home care or visiting nurse experience providing clinical care to patients in their homes required.
At least 2 years of payer-side prior authorization or utilization review experience required.
Payer-side experience reviewing home care or home health authorization requests required.
Experience applying InterQual or comparable evidence-based criteria to clinical documentation required.
Managed care or health insurance experience required.
Experience working under defined productivity expectations while maintaining quality, accuracy, and regulatory turnaround times required.
Medicare and Medicaid knowledge preferred.
Strong clinical judgment and critical-thinking skills.
Excellent written and verbal communication skills.
Strong organizational and time-management skills with the ability to manage a high-volume caseload independently.
Proficiency with Microsoft Office applications and utilization management or clinical data systems.
Ability to take after-hours calls, including evenings, nights, or weekends, as required.
Ability to comply with all organizational remote-work requirements.

Work Arrangement: Fully remote, with possible travel to Charlestown, Massachusetts for training or team meetings.

Pay Rate: $50.00–$53.00 per hour

If you are interested in this position, please send your resume to [email protected].

IND123

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Refine Your Search

clinician jobs in melrose ma

Prior Authorization Clinician - Home Care

Licensed Therapist

RN, Home Care

Mohs Surgical Assistant (20 hours)

School Registered Nurse (RN)

Clinical Documentation Specialist II- RN- Remote

CARE Clinician

Student Assistance Program ACRA Clinician, Gloucester

School- Based Behavior Technician (BT)

Mental Health Clinician and Group Facilitator for Teens and Parents

Senior Licensed Clinician

Licensed Clinical Supervisor

Physical Therapist Outpatient Ortho & Sports | PT-Owned Practice | Westford

Physical Therapist — Quality Care, 12 Patients/Day

Physical Therapist

Pediatric Occupational Therapist

Physical Therapist

Physical Therapist - $15,000 Welcome Bonus

Physical Therapist – Orthopedic Outpatient | No Productivity Quotas | Clinical Autonomy

Crisis Clinician - Boston CBHC AMCI

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