- Magellan Health Services (Baton Rouge, LA)
- …family engagement, and system-level collaboration with other child-serving agencies. The Clinical Reviewer will support the implementation and ongoing oversight ... staff. + Provides training, interpretation and support for QI Clinical Reviewer staff. + Audits and validates internal audit results and/or corrective… more
- HCA Healthcare (Houston, TX)
- …apart from any other healthcare provider. We are seeking a(an) Registered Nurse Clinical Reviewer to join our healthcare family. **Benefits** The Woman's ... empowers their passion for patient care. Apply today for our Registered Nurse Clinical Reviewer opportunity. **Job Summary and Qualifications** We are seeking a… more
- University of Miami (Hialeah, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... Concurrent Quality Reviewer of our hospital reviews documentation in the electronic...the computer assisted coding software, recognizing inappropriate application of clinical coding regulations/guidelines, and revising the codes assigned based… more
- HCA Healthcare (Kingwood, TX)
- **Description** **Introduction** Do you have the career opportunities as a(an) RN Clinical Reviewer you want in your current role? We invest in what matters most ... **Job Summary and Qualifications** We are seeking a RN Clinical Reviewer for our facility to ensure...for our Registered Nurse RN Emergency Department opening. We review all applications. Qualified candidates will be contacted by… 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
- SSM Health (MO)
- …Type:** Regular **Job Highlights:** Must have prior and direct Clinical Documentation experience **Preferred Qualifications:** + CCDS certification + Proficiency ... **Required Qualifications:** + Prior experience as a Second Level Reviewer + Two years in an acute care setting...in an acute care setting with two years experiencein clinical documentation or 4 years experience in clinical… more
- CVS Health (Austin, TX)
- …And we do it all with heart, each and every day. **Position Summary** The Clinical Nurse Reviewer will serve as the designated lead for STAR Kids rolling ... accurate, and audit-ready documentation. The position requires critical thinking, clinical knowledge, and excellent organizational skills to maintain ongoing audit… more
- US Tech Solutions (Canton, MA)
- …possible extension)** Notes: Fully remote, MA license required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- ... a clinically complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical necessity and,… more
- Catholic Health Initiatives (Lexington, KY)
- **Responsibilities** **JOB SUMMARY:** The Bariatric Clinical Reviewer plays a crucial role in ensuring departmental compliance with MBSAQIP Data Registry and ... 12 months of hire Experience: Three (3) to five (5) years of clinical experience. Skills: Current Basic Life Support for Healthcare Provider certification. The RN… more
- LGC Group (Petaluma, CA)
- …bioinformatics, biology, chemistry, manufacturing and analytical services that support discovery, pre- clinical and clinical trials and scale-up manufacture. With ... to cGMP of multigram to kilograms of API for pre- clinical and clinical development. Our site in...and analytical expertise in Kulmbach. Job Description The Technical Reviewer in LGC AxoLabs Quality Control is a dual… more
- St. George Tanaq Corporation (Lansing, MI)
- …and Skills** + One (1) year of Medicare appeals, medical review , clinical , healthcare regulatory interpretation/application, healthcare compliance or related ... Dispute Resolution Reviewer I Fully Remote*GA Job Type Full-time Description...or related discipline Additional experience in Medicare appeals, medical review , clinical , or other related experience in… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: High-level clinical review of patients admitted to the University Hospital for the purpose of risk identification and referral to clinical ... agencies and conduct internal quality reviews through the institution-defined quality review process. Supports the Attorney General's office in the review… more
- The Cigna Group (Sacramento, CA)
- …acuity cases, and/or account sensitive cases involving largest reserves. Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate ... for inpatient acute care, rehabilitation, referrals, and select outpatient services. May review initial liability disability claims to determine extent and impact of… more
- Elevance Health (Los Angeles, CA)
- …or requires physician review or override. + Clearly and concisely documenting clinical review and other case interactions in online database in adherence to ... **JR147375 Genetic Counselor Reviewer ** The genetic counselor reviewer (GCR)...for authorization requests and determining their appropriateness per designated clinical guidelines, clinical policies, and client rules.… more
- Commonwealth Care Alliance (Boston, MA)
- …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...direct reports. **Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior… more
- Elevance Health (Chicago, IL)
- **Nurse Reviewer I** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in person 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 (Grand Prairie, TX)
- **Nurse Reviewer I** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person 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
- Centene Corporation (Frankfort, KY)
- …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, ... a fresh perspective on workplace flexibility. **Centene is Hiring: Remote Psychologist Reviewer (ABA) - Kentucky Market** **Join Centene's mission-driven team as a… more
- St. George Tanaq Corporation (Little Rock, AR)
- …+ Must have 2-3 years of medical dispute resolution or Medicare appeals, medical review , clinical , or related experience in a healthcare setting + Healthcare ... Dispute Resolution Reviewer III Fully Remote*GA Job Type Full-time Description...or related discipline. Additional experience in Medicare appeals, medical review , clinical , or other related experience in… more