- HCA Healthcare (Pulaski, VA)
- …example, upon review of documentation indicating a broken bone, the clinical chart reviewer will request diagnostic images. Performs patient registration ... join an organization that invests in you as a(an) Clinical Reviewer ? At LewisGale Hospital Pulaski, you...and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. +… more
- University of Miami (Hialeah, FL)
- … this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Clinical Documentation Integrity (CDI) Second Level ... as key resource for CDI/Coding/Quality. The CDI Second Level Reviewer works in collaboration with CDI & quality leadership,...+ At least three (3) years of direct patient care clinical experience in hospital setting preferred.… more
- Kepro (Richmond, VA)
- …team. Job Summary: Our Clinical Reviewer RN will use clinical expertise to review medical records against appropriate criteria in conjunction with ... the public sector. Acentra seeks a Behavioral Health UM Clinical Reviewer RN to join our growing...and critical thinking skills. + 1+ year of Utilization Review (UR) and/or Prior Authorization or related… more
- Commonwealth Care Alliance (Boston, MA)
- …Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical and service authorization review for medical necessity and ... (UM) Reviewer is responsible for day-to-day timely clinical and service authorization review for medical...Be Doing:** + Conducts timely clinical decision review for services requiring prior authorization in… more
- Kepro (Richmond, VA)
- …appeals process with our client. UM Clinical Reviewer : + Using clinical knowledge and nursing experience, to review and interpret patient records and ... reviewer role - you will utilize clinical expertise for the review of medical...to investigate and resolve the outcomes of complaints. + Prior experience in healthcare/managed care appeals +… more
- Guthrie (Sayre, PA)
- …and requirements for prior authorization/certification for reimbursement of patient care services. The Utilization Reviewer : * Secures authorization as ... Position Summary: The Utilization Management (UM) Reviewer , in collaboration with other internal and external...eligibility for licensure required Experience: Minimum of five years clinical experience in an acute health care … more
- Elevance Health (Walnut Creek, CA)
- **Nurse Reviewer I** **Location:** Within 50 miles of a pulse point in the following states: + California + Washington + Nevada **Shift** : An 8-hour shift from 9:30 ... am - 6 pm **P** **ST** The **Nurse Reviewer I** is responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for… more
- Atlantic Health System (Morristown, NJ)
- …new methods and technologies, initiating studies, troubleshooting during the process, and review of experiments prior to submission where applicable. + ... The Laboratory Quality Improvement Coordinator/ Reviewer assists and supports the Quality Manager in...work in Healthcare - Becker's Healthcare + 100 Accountable Care Organizations to Know - Becker's Hospital Review… more
- IQVIA (Parsippany, NJ)
- …improvement initiatives. Qualifications * Bachelor's Degree Degree in scientific discipline or health care preferred. Req * Prior clinical trial experience ... experience and training. * Manage the quality of assigned staff's clinical work through regular review and evaluation of work product. * Identifies quality risks… more
- CVS Health (Austin, TX)
- …for a Clinical Pharmacist with CVS Health. This position is for a Clinical Pharmacist working in the Prior Authorization team. - Collaborates with the ... within the designated service level agreements. - Evaluate and review all prior authorization requests and render...a PBM setting. * Current experience working with commercial Prior Authorizations in PBM* Experience using clinical … more
- SUNY Upstate Medical University (Syracuse, NY)
- …a minimum of 3 years clinical practice experience. Preferred Qualifications: Primary care clinical experience & prior education experience preferred Work ... Summary: This full-time position is responsible for teaching didactic and clinical courses and participating in curriculum development and evaluation. Other… more
- UNC Health Care (Raleigh, NC)
- …Ensures appropriate and adequate clinical staffing and skill mix to meet patient care needs on own shift and upcoming shift. Effectively uses clinical and ... is a 30-bed medical-surgical unit that specializes in the care of the orthopedic patient. Our nurses provide exceptional...orthopedic program has been nationally recognized by Becker's Hospital Review and US News & World Report Hospitals Ranking.… more
- UNC Health Care (Raleigh, NC)
- … Nurse III demonstrates clinical leadership skills through contribution to standards of care and unit goals. The Clinical Nurse III serves as a role model ... is a 30-bed medical-surgical unit that specializes in the care of the orthopedic patient. Our nurses provide exceptional...orthopedic program has been nationally recognized by Becker's Hospital Review and US News & World Report Hospitals Ranking.… more
- Highmark Health (Wexford, PA)
- …Reviews pharmacy utilization management (UM) coverage requests and prepares such cases for clinical review by a pharmacist and/or medical director when required. ... :** **JOB SUMMARY** This position supports the network centralized prior authorization department. Coordinates and administers the effective and efficient… more
- UNC Health Care (Chapel Hill, NC)
- …The University of North Carolina Hospitals and Clinics Department of Pharmacy's Acute Care Services Team has an immediate opening for a highly motivated individual ... interested in providing patient care to our adult intensive care patient...state of North Carolina and the region. The MICU Clinical Pharmacist will work in a multidisciplinary environment alongside… more
- UNC Health Care (Butner, NC)
- …unique communities we serve. **Summary** : Youth Behavioral Hospital is hiring a Clinical Pastoral Education Specialist to join their team! The Clinical Pastoral ... Clinical Pastoral Education, Inc. (ACPE) accredited programs of Clinical Pastoral Education (CPE), including reviewing applications, conducting admission… more
- HCR Home Care (Rochester, NY)
- …of the computer software. Notify staff , as appropriate , to ensure proper coordination of care . + Review and approve all interim orders before they are sent to ... This position is an integral component of the patient care team and continually monitors the services provided. This...physician . Notif y Clinical Manager when unable to approve the order. +… more
- UNC Health Care (Raleigh, NC)
- …case managers, and pharmacists to name a few. Summary: Provides competent clinical nursing care consistent with professional standards. Reporting and accountable ... is a 30-bed medical-surgical unit that specializes in the care of the orthopedic patient. Our nurses provide exceptional...orthopedic program has been nationally recognized by Becker's Hospital Review and US News & World Report Hospitals Ranking.… more
- Centene Corporation (Little Rock, AR)
- …with interdepartmental teams on projects within utilization management as part of the clinical review team + Partners and works with Medical Affairs and/or ... + Partners with leadership to identify opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines +… more
- UNC Health Care (Chapel Hill, NC)
- …and well-being of the unique communities we serve. Summary: Provides competent clinical nursing care consistent with professional standards. Reporting and ... UNC Hospitals RN Incentive Program here: https://jobs.unchealthcare.org/pages/unc-hospitals-nurse-incentive-program + Acute Care General Medicine Unit with 15 Beds + Nurse… more