Teams at Boston Medical Center (BMC)

Responsible for utilization review, pre-denial/denial and appeals management using InterQual/MCG criteria. Reviews medical necessity, secures authorizations, researches and appeals denials, identifies trends, collaborates with clinicians, case managers, revenue cycle, and reports outcomes to reduce financial risk and maximize reimbursement within regulatory requirements.

The Senior Pharmacy Business Analyst translates data into insights for pharmacy services, monitors performance, develops dashboards, and partners with stakeholders to drive decision-making.

Lead development and delivery of clinical research datasets and reports from the Clinical Data Warehouse. Translate research needs into SQL queries and reusable data marts, standardize data across source systems, maintain SOPs and audit logs, enforce access controls and IRB compliance, support analyses/sample-size estimates, and drive process improvement and data optimization initiatives across the health system.