Top 76 Document reviewer Jobs in Norwood, 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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3d
Facilities Engineer
Johnson Controls —Burlington, MA
- $76,100 - $114,100 a year
- Full-time
- OSHA
- 3 years
- Ability to lift 50 pounds
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IRB Compliance Administrator
MIT —Cambridge, MA
- $79,050 - $106,420 a year
- Full-time
- Hybrid work
- 3 years
- Administrative experience
- Bachelor's degree
Graduate Program Staff Assistant
Harvard University —Cambridge, MA
- Overtime
- Hybrid work
- Office
- 3 years
- University
- Commuter assistance
- Health insurance
English Contract Attorney
Contact Government Services, LLC —Boston, MA
- $27 - $40 an hour
- Contract
- Remote
- English
- Mid-level
- 2 years
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Eligibility Reviewer
Tetra Tech —Boston, MA
- $25 an hour
- Overtime
- Bilingual
- Microsoft Excel
- Mid-level
5d
RN Reviewer
Cohere Health —Boston, MA
- $33 - $35 an hour
- Weekends as needed
- Remote
- Google Workspace
- Nursing
- RN License
- Paid parental leave
- Health savings account
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Client Coordinator
MES Solutions —Norwood, MA
- $17 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Medical office experience
- 401(k)
- Paid time off
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Director, Portfolio Development Process & Standards Lead
CSL Behring —Waltham, MA
- $230,000 - $270,000 a year
- Full-time
- Hybrid work
- Nursing
- Office
- 3 years
New Business Intake Research Analyst
McCarter & English —Boston, MA
- $70,000 - $90,000 a year
- Full-time
- Hybrid work
- Microsoft Word
- Background check
- Microsoft Outlook
- Health savings account
- AD&D insurance
14d
Research Manager, HBS AI Institute
Harvard Business School —Boston, MA
- Full-time
- Hybrid work
- 5 years
- Writing skills
- University
- Commuter assistance
- Health insurance
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Graphic Designer
Center For Health Information And Analysis —Boston, MA
- $66,890.20 - $117,590.46 a year
- Online Application
- Hybrid work
- Mid-level
- Office
- Administrative experience
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Manager, Medical Information
Sequel Med Tech —Marlborough, MA
- $75,000 - $140,000 a year
- Extended hours
- Hybrid work
- Nursing
- Medicine
- 5 years
- Health savings account
- Paid holidays
Senior Director Regulatory Affairs, US Advertising and Promotion
Merck KGaA —Boston, MA
- $258,300 - $387,500 a year
- 7 years
- Office
- Bachelor's degree
- Health insurance
- Paid time off
Proposal Writer
Uwill —Natick, MA
- $80,000 - $100,000 a year
- Full-time
- Hybrid work
- Microsoft Word
- Research
- Mid-level
- Paid holidays
- Dental insurance
Quick Apply
Part-Time Contract Statistical Programmer
Keros Therapeutics —Lexington, MA
- $114 - $133 an hour
- Part-time
- Remote
- Computer Science
- 8 years
- Senior level
Manager, Legal Operations & Compliance
Innoviva Specialty Therapeutics —Waltham, MA
- $135,000 - $150,000 a year
- Full-time
- Microsoft Excel
- 5 years
- Adults
Quick Apply
Director, US Regulatory Advertising & Promotion (Remote)
Ipsen Biopharmaceuticals Inc. —Cambridge, MA
- $177,000 - $260,000 a year
- Full-time
- Remote
- English
- 8 years
- Bachelor's degree
7d
Director, Regulatory Advertising and Promotion
Merck KGaA —Boston, MA
- $210,900 - $316,300 a year
- Office
- 8 years
- Bachelor's degree
- Health insurance
- Paid time off
Senior Director, Regulatory Advertising and Promotion
Merck KGaA —Boston, MA
- $210,900 - $316,300 a year
- 7 years
- Office
- Bachelor's degree
- Health insurance
- Paid time off

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document reviewer jobs near norwood, ma

Prior Authorization Clinician - Home Care

Daley and Associates -
Charlestown, MA

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Job Details

Contract
$50 - $53 an hour
3 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

document reviewer jobs in norwood, ma

Prior Authorization Clinician - Home Care

Facilities Engineer

IRB Compliance Administrator

Graduate Program Staff Assistant

English Contract Attorney

Eligibility Reviewer

RN Reviewer

Client Coordinator

Director, Portfolio Development Process & Standards Lead

New Business Intake Research Analyst

Research Manager, HBS AI Institute

Graphic Designer

Manager, Medical Information

Senior Director Regulatory Affairs, US Advertising and Promotion

Proposal Writer

Part-Time Contract Statistical Programmer

Manager, Legal Operations & Compliance

Director, US Regulatory Advertising & Promotion (Remote)

Director, Regulatory Advertising and Promotion

Senior Director, Regulatory Advertising and Promotion

I want to receive the latest job alert for document reviewer in norwood, ma

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