- Raytheon (Tucson, AZ)
- …initiatives.Coordinate program and department staffing needs, optimizing resource utilization , and supporting recruitment and retention efforts.Perform individual ... oversight to programs' product life cycle (design reviews, gate reviews, Material Review Board, Change Control Board, Process Change Board, and engineering peer… more
- Raytheon (Tucson, AZ)
- …initiatives.Coordinate program and department staffing needs, optimizing resource utilization , and supporting recruitment and retention efforts.Perform individual ... oversight to programs' product life cycle (design reviews, gate reviews, Material Review Board, Change Control Board, Process Change Board, and engineering peer… more
- Raytheon (Aurora, CO)
- …Management teams to streamline schedules, Monitor ICITE efficiencies, create and review related design documentation for the program.What You Will DoYou will ... Experience in managing and monitoring cloud environments, including resource utilization , performance, and securityCloud Security and Compliance, Problem-solving and… more
- US Tech Solutions (Canton, MA)
- …Fully remote, but Massachusetts RN license required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that is expected ... a clinically complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical necessity and, therefore,… more
- Commonwealth Care Alliance (Boston, MA)
- …and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets ... Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …us transform healthcare? Bring your true colors to blue. The Role The RN Utilization Management Reviewer is responsible for facilitating care for members who may ... benefit to provide the best quality care. The Team The RN Utilization Management Reviewer is part of a highly dedicated and motivated team of professionals,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member… more
- Koniag Government Services (Germantown, MD)
- …weapons design, nuclear material production, counterintelligence, weapon science, and military utilization of nuclear weapons to review and assess documents. ... Document Reviewer Level 5 (DRL5) Germantown, MD, USA Req...design, nuclear material production, counterintelligence, weapon science, and military utilization of nuclear weapons. **Essential Functions, Responsibilities & Duties… more
- Koniag Government Services (Germantown, MD)
- Document Reviewer Level 2 (DRL2) Germantown, MD, USA Req #217 Wednesday, April 23, 2025 **Koniag Professional Services** , a Koniag Government Services company, is ... seeking a Document Reviewer Level 2 (DRL2) with a Top-Secret clearance to...* Weapon science and inertial confinement fusion * Military utilization of nuclear weapons * Recognizing the potential for… more
- Koniag Government Services (Germantown, MD)
- Document Reviewer Level 1 (DRL1) Germantown, MD, USA Req #218 Wednesday, April 23, 2025 **Koniag Professional Services** , a Koniag Government Services company, is ... seeking a Document Reviewer Level 1 (DRL1) with a Top-Secret clearance to...* Weapon science and inertial confinement fusion * Military utilization of nuclear weapons * Determining whether documents potentially… more
- Magellan Health Services (Baton Rouge, LA)
- …engagement, and system-level collaboration with other child-serving agencies. The Clinical Reviewer will support the implementation and ongoing oversight of quality ... clinical staff. + Provides training, interpretation and support for QI Clinical Reviewer staff. + Audits and validates internal audit results and/or corrective… more
- Koniag Government Services (Germantown, MD)
- Document Reviewer Level 3 (DRL3) Germantown, MD, USA Req #216 Wednesday, April 23, 2025 **Koniag Professional Services** , a Koniag Government Services company, is ... seeking a Document Reviewer Level 3 (DRL3) with a Top-Secret clearance to...* Weapon science and inertial confinement fusion * Military utilization of nuclear weapons * Determining whether information is… more
- Elevance Health (Mason, OH)
- **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
- Elevance Health (San Juan, PR)
- …information technology and business operations services for health plans._ **Nurse Reviewer I** **Location:** This role requires associates to be in-office 1 ... Friday but must be flexible according to business needs. The **Nurse Reviewer I** is responsible for conducting preauthorization, out of network and appropriateness… 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 ... in Hospital medicine preferred + At least one (1) year of utilization review experience preferred We're ChenMed and we're transforming healthcare for seniors and… more
- Magellan Health Services (Albuquerque, NM)
- …clinical staff. + Provides training, interpretation and support for QI Clinical Reviewer staff. + Audits and validates internal audit results and/or corrective ... management and verbal and written communication skills. Knowledge of utilization management procedures, Medicaid benefits, community resources and providers.… more
- Hartford HealthCare (Hartford, CT)
- …The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection, documentation, ... multiple time intervals over the course of the patient's care through effective utilization of the hospital and surgeons' office record systems. . Works in… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …track record in the analysis of clinical records, claim and FWA audits, utilization review and quality assurance + Advanced knowledge of clinical terminology ... Position Purpose: The Clinical Reviewer serves as a subject matter expert in...serves as a subject matter expert in the clinical review of claims, claim disputes, appeals and FWA special… 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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …most appropriate decision within regulatory timeframes.The TeamAs an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a ... expert for member and provider submitted appeals. Working collaboratively with Physician review unit, Utilization Management, Case Management, Member appeals and… more
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