- VitalCore Health Strategies (Smyrna, DE)
- …Strategies (VCHS), an industry leader in correctional healthcare, has an opening for a Physician at James T Vaughn Correctional Center in Smyrna, DE!! ( Can sponsor ... of the hard work and dedication of our staff. PHYSICIAN BENEFITS PACKAGE: * Holiday Pay: New Year's Day,...staff. * Ensure and provide on-call services. * Annually review and approve clinical protocols, policies and procedures, and… more
- VitalCore Health Strategies (Jackson, MI)
- …, Michigan! View our opportunities at: https://vitalcorehs.com/careers (https://vitalcorehs.com/careers) PHYSICIAN /MEDICAL DIRECTOR (MD / DO) BENEFITS PACKAGE TO ... Annual Incentive Bonus * Dependent Care Flexible Spending Account PHYSICIAN /MEDICAL DIRECTOR (MD / DO) POSITION SUMMARY The Staff...education of staff as requested. * Participates in monthly review of quality care and chart reviews as requested.… more
- VitalCore Health Strategies (Hopkinton, MA)
- …direction and assistance to the on-site quality improvement program, including review of grievances and development of corrective action plans involving patients ... their assigned contracts. * Ensure compliance with re-credentialing * Ensure review of patient care information (laboratory results and previous QNXT documents)… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …adjudicate these requests. At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical ... Bring your true colors to blue. The Role The Physician Reviewer is responsible for evaluating clinical..., in partnership with case managers + Participate in Physician Psychologist Review Units' appeal process of… more
- ChenMed (Miami, FL)
- …The Physician Reviewer is the primary physician reviewer for Utilization Management/Clinical Appropriateness review cases in our organization. Other ... duties include advising other physician reviewers and attending daily calls with health plan...preferred + At least one (1) year of utilization review experience preferred **PAY RANGE:** $198,797 - $283,995 Salary… more
- Chenega Corporation (Rockville, MD)
- …a **Chenega Professional Services Strategic Business Unit** company, is looking for a Physician - Contract Medical Reviewer (CMR) to support the Department of ... or License to practice in the US as a physician 's assistant or nurse practitioner. + Licensure: Must possess...MD location. + Professional Background: Relevant experience in claims review , healthcare administration, or related fields. + A minimum… more
- Kelly Services (Raleigh, NC)
- …community and earn extra income? Join Kelly Government Solutions as a Physician Disability Reviewer , performing one-time Disability Evaluations (DBQs) for ... **Become a Physician Disability Evaluator for Veterans - Raleigh, North...VA benefits purposes._ **Who We're Looking For** + **Licensed Physician ** (MD or DO only) + **Active, unrestricted US… more
- Evolent (Olympia, WA)
- …Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/ Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support and assistance for ... with the Director of UM to ensure client satisfaction. Perform all peer clinical review activities while located in a state or territory of the United States. Acts… more
- Kelly Services (Pensacola, FL)
- …Government Solutions team: Proudly Serving Those Who Served** Are you a licensed ** Physician ** (MD or DO), or **autonomous NP or PA** seeking meaningful work that ... Role** + Perform one-time veteran disability evaluations (DBQs/C&P exams) + Review health histories, assess whether injuries/conditions are likely service-related +… more
- AmeriHealth Caritas (Lafayette, LA)
- …for approval or denial decisions. + Identify and escalate complex cases requiring physician review or additional intervention. + Ensure compliance with industry ... cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines to authorize… more
- AmeriHealth Caritas (Washington, DC)
- …for approval or denial decisions + Identify and escalate complex cases requiring physician review or additional intervention + Ensure compliance with Medicaid ... cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines to authorize… more
- Hartford HealthCare (Hartford, CT)
- …Island. We consist of a team of professionals ranging from Medical Assistants to Physician Assistants and everything in between. Our physician led medical group ... The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection, documentation,… more
- Carle Health (Peoria, IL)
- …Arts (LPHA) authorizing Integrated Assessment and Treatment Plans. Will complete thorough review of each document, provide clinical guidance to team members, and ... ensure compliance with IATP standards. LPHA reviewer provides behavioral health assessment, intervention, and consultation to individuals and/or groups identified as… more
- Guthrie (Cortland, NY)
- Summary The LPN Utilization Management (UM) Reviewer , in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, and the Robert ... care services. The responsibilities include: + Facilitating communication between physician offices, payers, Care Coordination and other hospital departments as… more
- Zelis (FL)
- …interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay ... Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest...provider in the form of medical records such as physician notes, lab tests, images (x-rays etc.), and with… more
- SSM Health (MO)
- …to clinical staff regarding these requirements during the concurrent record review process. + Maintains knowledge of mortality models, observed rate/expected rate ... (O/E ratios), industry trends, variable and diagnosis review group (DRG) frequency. + Serves as a liaison...of Clinical Documentation Improvement Specialists (ACDIS) + Or + Physician Assistant in Medicine, Licensed - Illinois Department of… more
- Kelly Services (Fargo, ND)
- Physician , NP, or PA Evaluator for Veterans - Flexible, Impactful, Supplemental Income **Become a part of the Kelly Government Solutions team: Proudly Serving Those ... Who Served** Are you a licensed MD, DO, Nurse Practitioner* (NP), or Physician Assistant* (PA) seeking meaningful work that fits seamlessly into your current… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member ... and treatment of members' behavioral health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member ... and treatment of members' medical health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as well… more
- Zelis (NJ)
- …evidence supplied by the provider in the form of medical records such as physician notes, lab tests, images (x-rays etc.), and with due consideration to any ... applicable medical policies, medical best practice, etc. + Implement and conduct quality assurance program to ensure accurate results to our clients + Manage assigned claims and claim report, adhering to client turnaround time, and department Standard… more
