- Corewell Health (Grand Rapids, MI)
- …in clinical setting + 3 years of relevant experience Managed care experience + LIC- Physician (MD) - STATE_MI State of Michigan or LIC-Osteopathic Physician (DO) ... Michigan Preferred + Proven experience and evidence of success in effective physician communication and education skills + Evaluation of evidence-based standards of… more
- Kelly Services (St. Louis, MO)
- …Government Solutions is seeking Healthcare Providers **(Physicians - MD, DO, Physician Assistants PA, or Nurse Practitioners NP)** to conduct one-time disability ... exams for Veterans. Veterans are in need of assistance for their service-connected disability exams and we are searching for healthcare providers looking to supplement your income while gaining valuable insight into military culture. You will be conducting… more
- Elevance Health (Los Angeles, CA)
- …determining whether clinical information presented meets medical necessity criteria or requires physician review or override. + Clearly and concisely documenting ... **JR147375 Genetic Counselor Reviewer ** The genetic counselor reviewer (GCR) is...clinical review and other case interactions in online database in adherence… more
- SSM Health (MO)
- …specialized mortality reviews. **Required Qualifications:** + Prior experience as a Second Level Reviewer + Two years in an acute care setting with two years ... to clinical staff regarding these requirements during the concurrent record review process. + Maintains knowledge of mortality models, observed rate/expected rate… 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...Documentation Specialists for concurrent queries to the providers, ensuring physician responses to queries are reflected in the code… 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
- Magellan Health Services (Honolulu, HI)
- …and company policies and procedures, and criteria. + Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding ... quality of care. General Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work Experience - Required Clinical Work Experience -… 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 other ... **-** Provides medical records to requesting parties (Attorneys, Government offices, physician offices, patients, **etc.** ) 3. General Administrative - Loading of… more
- The Cigna Group (Sacramento, CA)
- …implements, and evaluates appropriate health care services in conjunction with the physician treatment plan. Handles more complex, high acuity cases, and/or account ... for inpatient acute care, rehabilitation, referrals, and select outpatient services. May review initial liability disability claims to determine extent and impact of… more
- The Joint Commission (Oakbrook Terrace, IL)
- …and programs that meet DSC certification eligibility criteria. Plans, reviews and apportions review time so that all review requirements are addressed thoroughly ... per program. Reviews and evaluates pre- review information; researches, collects, organizes, and interprets a large volume of information from multiple sources.… more
- Virtua Health (Marlton, NJ)
- …than 14,000 colleagues, including over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, ... of RN experience. Coding Experience preferred; Oasis Experience preferred. Job Summary: Review of Home Health OASIS documentation tool and other necessary clinical… more
- Prime Healthcare (North Las Vegas, NV)
- …strong relationships and business development activities of the division, including physician and community relations programs. Responsible for achieving goals and ... Performance Reporting and Selling. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/197871/bariatric-clinical- reviewer /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityNorth Vista Hospital LocationUS-NV-North Las Vegas… more
- MTA (Brooklyn, NY)
- Administrative Physician , Leave and Medical Review Job ID: 11631 Business Unit: MTA Headquarters Location: Brooklyn, NY, United States Regular/Temporary: Regular ... Services Date Posted: Apr 30, 2025 Description JOB TITLE: Administrative Physician , Leave and Medical Review SALARY : $ 190,000 - $ 195,000 DEPT/DIV: HQ/… more
- Merck (North Wales, PA)
- **Job Description** The Medical Consult and Review Physician provides clinical expertise and advice to internal stakeholders and is a member of several ... Teams. In Promotional Review Team, the Medical Consult and Review Physician is responsible for ensuring the clinical relevance and medical accuracy of… more
- Chenega Corporation (San Antonio, TX)
- …Management + Review trainee case adjudications for quality assurance. + Review a percentage of Independent Case Reviewer (ICR) case adjudications for ... reviews must uphold the requirements for a policy compliant review as per the Independent Case Reviewer ...compliant review as per the Independent Case Reviewer certification requirements of C2 Alaska, LLC. + Consult… more
- WMCHealth (Valhalla, NY)
- …and/or Case management Physician Advisor or having 3-5 years as a Physician Reviewer /Advisor with a third party leveling and/or appeals agency preferred. ... Physician Advisor Company: WMC Advanced Physician ...when clinical determinations cannot be made by initial clinical review . + Discusses determinations with requesting physicians or ordering… more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …section, service or facility level committees/boards, when assigned. Serve as Peer Reviewer for the Protected Peer Review Committee, when assigned. Demonstrate ... FPPE/OPPE process. Adheres to employee health requirements. Timely participates in peer review process. (4) Time/Leave Management: Adherence to tour of duty and… more
- Logan Health (Kalispell, MT)
- Join Logan Health as an RN Analyst - Physician Peer Review ! Our Mission: Quality, compassionate care for all. Our Vision: Reimagine health care through ... Logan Health has an exciting opportunity for an RN Analyst - Physician Peer Review to join our dedicated team in beautiful Kalispell, Montana! In this… more