- Prime Therapeutics (Washington, DC)
- …fuels our passion and drives every decision we make. **Job Posting Title** Physician Clinical Reviewer - GI- REMOTE **Job Description Summary** Key member of the ... utilization management team, and provides timely medical ...clinical determinations cannot be made by the Initial Clinical Reviewer . + Discusses determinations with requesting… more
- Evolent Health (Washington, DC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Physician Clinical Reviewer you will be a key member of the utilization ... when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the… more
- Prime Therapeutics (Washington, DC)
- …efforts in the development of medical pharmacy solutions programs. Supports drug utilization review (DUR) efforts by reviewing physician prescribing patterns, ... that. It fuels our passion and drives every decision we make. **Job Posting Title** Clinical Pharmacist Reviewer - REMOTE **Job Description Summary** Facilitates… more
- The Arora Group (Bethesda, MD)
- … Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in Bethesda, Maryland to provide care to Active Duty heroes, their ... The Contractor performing as the License Practical Nurse (LPN) Utilization Reviewer (UR) shall make coverage decisions...+ Experience: Requires a minimum of 2 years of clinical and utilization review experience… more
- Elevance Health (Washington, DC)
- …+ Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care . + Participate on committees ... as part of consideration for employment. **Medical Oncology Medical Director - Utilization Review ** + Job Family: MED > Licensed Physician/Doctor/Dentist +… more
- Prime Therapeutics (Washington, DC)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Clinical Review Pharmacist **Job Description** The Clinical Staff Pharmacist is ... pre-approved criteria + Accountable for direct consultation with health care providers concerning non-formulary and clinical product...+ Reports to a Supervisor or Manager in the Clinical Review department Potential pay for this… more
- Centerwell (Annapolis, MD)
- … of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts ... caring community and help us put health first** The Clinical Manager coordinates and oversees all direct care...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- Fresenius Medical Center (Lanham Seabrook, MD)
- **About this role:** As a Clinical Manager with Fresenius Medical Care , you will ensure that quality patient care is delivered while maintaining clinical ... will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal… more
- Prime Therapeutics (Washington, DC)
- …and written communication skills. + Knowledge of legislative/oversight bodies (eg, URAC- Utilization Review Accreditation Commission, CMS-Centers for Medicare & ... drives every decision we make. **Job Posting Title** Director, Specialty Clinical Solutions- PharmD/RPH required- REMOTE **Job Description Summary** Responsible for… more
- United Therapeutics (Silver Spring, MD)
- …Health Canada + Perform administrative responsibilities; to include: Participate in clinical review meetings and other administrative and scientific activities; ... control and quality assurance activities, including deviation documentation and SOP review ; Collaborate and perform experiments with pre- clinical and… more
- Boehringer Ingelheim (Washington, DC)
- …community. **Requirements** * Bachelor's degree required in Nursing or equivalent health care discipline such as Licensed Clinical Social Worker (LCSW), ... This may include: prescribing and non-prescribing healthcare stakeholders, patients, care partners, consumers, community organizations, and advocacy partners. Works… more
- Elevance Health (Washington, DC)
- …Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of- care savings across an expanding set of clinical domains, including ... being performed. Preferred: -Leadership experience managing teams of physicians in a utilization management clinical operations business inside a health plan or… more
- Prime Therapeutics (Washington, DC)
- …educational, and/or resident experience to include at least 5 years of experience in managed care or clinical pharmacy + Must be eligible to work in the United ... fuels our passion and drives every decision we make. **Job Posting Title** Clinical Program Management Director - Remote **Job Description** The Clinical Program… more
- Conduent (Elkridge, MD)
- …methodologies to identify trends and address gaps in care . + Review prior authorizations for clinical appropriateness and accuracy. **Requirements** + Active ... and analyses. Your innovative approach will be instrumental in shaping our clinical practices and optimizing patient care . **Responsibilities** + Ensure… more
- Conduent (Elkridge, MD)
- …and methods to understand trends, uncover gaps in care . Review prior authorizations for clinical appropriateness and accuracy **Requirements** . Have ... culture where individuality is noticed and valued every day. **Job Description:** ** Clinical Psychiatric Pharmacist** **Are you innovative and look for ways to… more
- Serco (Washington, DC)
- …+ Supervisory/managerial experience in the health insurance industry, a utilization review firm, or another health care claims processing organization + An ... PERM staff, as necessary, to provide and provide expert clinical guidance and technical assistance. + Provide expertise or...in the health insurance industry, a utilization review firm, or another health care claims… more
- Serco (Washington, DC)
- …+ Supervisory/managerial experience in the health insurance industry, a utilization review firm, or another health care claims processing organization. + An ... 2019 (PIIA). As part of this effort, Serco would execute the PERM review contract which includes collection of state eligibility policies and medical records;… more
- GAP Solutions Inc (Bethesda, MD)
- …documentation, electronically scans and uploads records into the electronic medical record. Review medical records to collect relevant clinical data. + Maintain ... Position Objective: Provide services as a Patient Care Coordinator in support of the overall functions of the National Institute of Allergy and Infectious Diseases… more
- Highmark Health (Washington, DC)
- … utilization management programs, and case/ disease management initiatives; providing clinical review and decisions for physician and member appeals and ... utilization management programs, and disease management initiatives. + Provide clinical review and decisions including but not limited to: physician… more
- Elevance Health (Arlington, VA)
- …+ Using tools and pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential ... check, or ask you for payment as part of consideration for employment. **Case Manager (Managed Care Coordinator)** + Job Family: MED > Care Coord & Care Mgmt… more