- Hartford HealthCare (Hartford, CT)
- …different specialties. The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely ... data registry activities, including program teleconferences and meetings. Maintains Surgical Clinical Reviewer (SCR) certification on an annual basis, in… more
- Evolent (Frankfort, KY)
- …the mission. Stay for the culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer , Nurse, you will be a key member of the utilization ... while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse, you will routinely interact...**What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases,… more
- Evolent (Helena, MT)
- …mission. Join a mission with a company behind it. **What You'll Be Doing:** As a Clinical Reviewer , Nurse, you will be a key member of the utilization management ... while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse, you will routinely interact...**What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases,… more
- BJC HealthCare (St. Louis, MO)
- …relevant work experience) **Additional Information About the Role** BJC is hiring for a Surgical/ Clinical Reviewer . This is a remote position. Must be located in ... medical schools in the country. **Preferred Qualifications** **Role Purpose** The Surgical Clinical Reviewer (SCR) is responsible for abstracting and sharing… more
- St. Luke's University Health Network (Bethlehem, PA)
- …of a patient's ability to pay for health care. The Admission's Clinical Reviewer is responsible for the comprehensive medical review and screening of all ... and responds to all inquiries for admission to ARC + Completes thorough review of documentation and information and assesses a patient's appropriateness for ARC… more
- Centers Plan for Healthy Living (Margate, FL)
- …applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …us transform healthcare? Bring your true colors to blue. The Role The Clinical Pharmacist Reviewer reviews formulary exception, prior authorization and quantity ... Network and Medical Utilization Management for pharmaceuticals programs + Partner with clinical and non- clinical teams for staff training, facilitation of… more
- AmeriHealth Caritas (Washington, DC)
- …SIGN ON BONUS** **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for ... on clinical criteria. Using professional judgment, the Clinical Care Reviewer assesses the appropriateness of...cases are escalated to the Medical Director for further review . The reviewer independently applies medical and… more
- AdventHealth (Orlando, FL)
- …year **The role you'll contribute:** Under general supervision of the Director of Clinical Documentation Integrity and in some situations the supervision of the ... Clinical Documentation Integrity Manager, and in collaboration with physicians,...with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality… more
- SSM Health (MO)
- …an auditor, and an educator ensuring medical records are complete and clinical documentation comprehensively represents the current health status of network patients ... and electronic health record charts that accurately capture the clinical picture. **Job Responsibilities and Requirements:** PRIMARY RESPONSIBILITIES + Reviews… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …rehabilitation and other services within scope of practice per business needs. The reviewer will ensure services align with established clinical guidelines and ... true colors to blue. The Role The Physical Therapy Utilization Management Reviewer is responsible for evaluating the appropriateness and medical necessity of… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …+ Participate in the development and refinement of utilization management protocols and clinical review tools. + Collaborate with internal departments such as ... Applied Behavior Analysis (ABA) services for LA Blue members. The BCBA Utilization Reviewer will review treatment plans, conduct utilization reviews, and ensure… more
- The Cigna Group (Bloomfield, CT)
- …clinical protocols; and authorizing coverage of services or referring requests for expert clinical review as appropriate. + Be available as an expert advisor ... responsible for the following: + Laboratory molecular and genetic testing clinical case review activities. + Evaluate telephone, fax, or web requests for… more
- Jabil (Hunt Valley, MD)
- …(IP) Testing + Clinical Verification + Packaging Material + Components + Review the data to Comply with GLPs, cGMPs, and GDP (Good Documentation Practice). + ... around the globe. Job Summary: The Quality Control Data Reviewer I is responsible for the accurate and timely... I is responsible for the accurate and timely review of analytical data generated in the QC laboratory.… more
- HCA Healthcare (Brownsville, TX)
- …want to join an organization that invests in you as a Coding Quality Audit Reviewer ? At Parallon, you come first. HCA Healthcare has committed up to $300 million in ... We are looking for a dedicated Coding Quality Audit Reviewer like you to be a part of our...result in appropriate reimbursement and data integrity. You will review outcomes are communicated to the HSC team to… more
- Ochsner Health (Slidell, LA)
- …in the hospital. Works closely with Departments to identify opportunities for clinical quality improvement and other special projects as may be identified. To ... including one year experience in hospital surgery department, surgery clinic, clinical research or medical records. **Certifications** Required - Current RN License… more
- Centene Corporation (Indianapolis, IN)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... on workplace flexibility. **Remote Opportunity** **Centene is Hiring - Remote Psychologist Reviewer (ABA)** **Centene is seeking a Remote Psychologist Reviewer … more
- ChenMed (Miami, FL)
- …to join our team. The Physician Reviewer is the primary physician reviewer for Utilization Management/ Clinical Appropriateness review cases in our ... Delegated Utilization Management. **ESSENTIAL JOB DUTIES/RESPONSIBILITIES:** + Provides Delegated Clinical Appropriateness Reviews by covering the specified territories as… more
- Elevance Health (IN)
- **Physical Therapist Reviewer ** **Work schedule: M-F 7:30am to 4:30pm EST.** **Location:** **Fort Wayne Indiana.** **This field-based role enables associates to ... is granted as required by law._ The **Physical Therapist Reviewer ** is responsible for performing medical record reviews specific...**How you will make an impact:** + Conducts medical review /claim review of beneficiary health records specific… more
- Cook Medical (West Lafayette, IN)
- …Scientific Communications Medical Reviewer to join our growing Scientific Communications/ Clinical team. Medical Reviewers provide medical review of documents ... 9-to-5 Eastern Standard Time schedule (Monday through Friday). Responsibilities Provide medical review of clinical and certain regulatory documents (including … more