- HCA Healthcare (Pasadena, TX)
- …your knowledge and expertise! **Job Summary and Qualifications** The RN Clinical Reviewer conducts a comprehensive current review of clinical documentation ... you have the career opportunities as a(an) RN Clinical Reviewer you want with your current employer? We have...encourage you to apply for our Registered Nurse Case Manager opening. We promptly review all applications.… more
- PeaceHealth (Vancouver, WA)
- …PeaceHealth Home Health in Vancouver, WA is seeking a Home & Community Quality Reviewer for a Per Diem/Relief, 0.00 FTE, Day position. The salary range for this ... Oregon, or Alaska. **Job Summary** Responsible for the quality review of all OASIS/HIS admission documents and Plan of...program compliance is met. Works closely with the System Manager of Quality for Home & Community along with… more
- AdventHealth (Altamonte Springs, FL)
- …and in some situations the supervision of the Clinical Documentation Integrity Manager , and in collaboration with physicians, nursing and HIM coders, the Second ... Level Reviewer I strategically facilitates and obtains appropriate and quality...(ROM), and quality. . Completes accurate and timely record review to ensure the integrity of documentation compliance. .… more
- Fluor (CA)
- … Manager - Reports of Investigation ("ROI") and the Utilities Senior Project Manager , the Utility Design Reviewer contributes alongside a team of Utility ... Design Reviewers to prepare, review , coordinate, and track all utility Reports of Investigation...Reports of Investigation for the Authority. The Utility Design Reviewer is responsible for preparing ROI reports in conformance… more
- Elevance Health (Nashville, TN)
- **Genetic Counselor Reviewer ** The Genetic Counselor Reviewer (GCR) is responsible for authorization requests and determining their appropriateness per ... for genetic tests from front-line intake. + Conducting medical necessity review in adherence to guidelines and determining whether clinical information presented… more
- Commonwealth Care Alliance (Boston, MA)
- …the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical and service authorization ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS compliance standards in the… more
- Elevance Health (Chicago, IL)
- **Nurse Reviewer I** **Location:** **Virtual:** This role enables associates to work virtually full-time, with the exception of required inperson training sessions, ... and ensures essential face-to-face onboarding and skill development. The **Nurse Reviewer I** will be responsible for conducting preauthorization, out of network… more
- ChenMed (Miami, FL)
- …join our team. The Physician Reviewer is the primary physician reviewer for Utilization Management/Clinical Appropriateness review cases in our organization. ... other physician reviewers. + Other duties as assigned and modified by manager . **KNOWLEDGE, SKILLS AND ABILITIES:** + Excellent analytical and deductive reasoning… more
- State of Georgia (Dekalb County, GA)
- Literacy Content Reviewer (Part-time) Georgia - Dekalb - Clarkston (https://careers.georgia.gov/jobs/65629/other-jobs-matching/location-only) Education ... Office of State Schools is recruiting a Literacy Content Reviewer . This role evaluates and revises learning content to...include but are not limited to the following: + Review literacy materials for DHH/BVI students to ensure accuracy,… 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 the territory/market that they will work in.** The **Physical Therapist Reviewer ** is responsible for performing medical record reviews specific to services… more
- Boston Public Schools (Boston, MA)
- …Program: Child and Adult Care Food Program Positions Available: After-School Food Program Reviewer Commitment Date: August 19, 2024 - June 30, 2025 [program start ... be reviewed at least three times per year. Each review is one hour long. A review ...of the BPS mileage reimbursement policy. Reports to: Nutrition Manager Responsibilities: Ensures that site personnel maintain accurate records… more
- City of New York (New York, NY)
- …for continued employment. The Office of Constituent Services /Ombudsman Case Reviewer within the Medicaid Eligibility Information Services (EIS) is responsible for ... (NAMI-Net Available Monthly Income) if institutionalized. - Interview and/or review documentation submitted by applicants/recipients (A/R) or authorized representatives,… more
- Elevance Health (Walnut Creek, CA)
- The **Therapy Services Reviewer ** is responsible for the review of medical records to determine if requests for therapy services (physical therapy, occupational ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …+ Uses a collaborative process to plan, assess, re-assess, implement, monitor, and evaluate the options and services required to meet the healthcare needs of the ... patients using the functions of Utilization Resource Management, Transition of Care, Discharge Planning, and Case Management. + Reviews the appropriateness of Severity Index/Intensity of Service for all acute care admissions utilizing evidence-based criteria… more
- Eurofins (King Of Prussia, PA)
- …stocks in Europe over the past 20 years. + Water Systems + GMP review of microbiological testing of the facility and/or laboratory water purification system samples. ... Tests included are LAL and Bioburden. + GMP review of analytical testing of the facility and/or laboratory...with Region Recruiter + 45-60 Minute Virtual Interview with Manager and/or Group Leader Additional Details: The position is… more
- The Cigna Group (Sacramento, CA)
- …for inpatient acute care, rehabilitation, referrals, and select outpatient services. May review initial liability disability claims to determine extent and impact of ... Knowledge of managed care preferred. + Works independently, receiving direction from manager or team leader for new or unprecedented situations. + Manages own… more
- Fallon Health (Worcester, MA)
- …and LinkedIn. **Brief summary of purpose:** Under the general supervision of the Manager of Configuration Audit and Directories, staff will perform an audit sampling ... training needs. Meets with Provider Specialist staff monthly to review error trends and collaborate solutions for issues related...records monthly to maintain provider linking knowledge. * May review P&Ps for updates needed and provide updates to… more
- AmeriHealth Caritas (Philadelphia, PA)
- …**Responsibilities:** Under the direction of the unit Supervisor, the Clinical Care Reviewer - Shift Care is responsible for managing requests for pediatric shift ... a request from a physician for shift care services, the Clinical Care Reviewer contacts the parent/guardian to complete a comprehensive assessment of the member's… more
- PNC (Tampa, FL)
- …or issues.Participates in continuous monitoring for assigned portfolios. + Oversees file review activities of reviewers as Reviewer in Charge for assigned ... success. We are looking to hire a Credit Risk Review Advisor Senior in Credit Risk Review ...credit exposures. You may have responsibility of being a Reviewer in Charge. The Reviewer in Charge… more
- Censeo Consulting Group (Washington, DC)
- Grants Review Program Manager - Department of Justice The Position: We are looking for eager, driven candidates with experience in people management, training, ... impactful solutions for Federal clients at the Department of Justice. The Grants Review Program Manager is responsible for providing logistical support for… more