- 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
- The Cigna Group (Sacramento, CA)
- …for inpatient acute care, rehabilitation, referrals, and select outpatient services. May review initial liability disability claims to determine extent and impact of ... cases for impact. + Access the approved Cigna guidelines for inpatient review and directs communication with the facility to elicit clinical information and… more
- US Tech Solutions (Canton, MA)
- …extension)** Notes: Fully remote, MA license required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that is ... a clinically complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical necessity and, therefore,… 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 (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
- Elevance Health (Los Angeles, CA)
- **JR147375 Genetic Counselor Reviewer ** The genetic counselor reviewer (GCR) is responsible for authorization requests and determining their appropriateness per ... requests for genetic tests from front-line intake. Conducting medical necessity review in adherence to guidelines and determining whether clinical information… more
- Koniag Government Services (Germantown, MD)
- Lead Document Reviewer Level 5 (DRL5) Germantown, MD, USA Req #320 Friday, April 25, 2025 **Koniag Professional Services, LLC,** a Koniag Government Services ... company, is seeking a Lead Document Reviewer Level 5 (DRL5) with Top- Secret clearance to support **KPS** and our government customer in Germantown, MD. We offer… more
- Centers Plan for Healthy Living (Margate, FL)
- …accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team ... support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine… more
- Centene Corporation (Frankfort, KY)
- …a fresh perspective on workplace flexibility. **Centene is Hiring: Remote Psychologist Reviewer (ABA) - Kentucky Market** **Join Centene's mission-driven team as a ... Remote Psychologist Reviewer specializing in Applied Behavior Analysis (ABA) for our...practitioners to provide education on best practice models and utilization management processes. + Interact with the Medical Director,… more
- Magellan Health Services (Honolulu, HI)
- …collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or ... outpatient care settings. Collects and analyzes utilization data. Assists with discharge planning and care coordination....Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 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 ... and long-term follow-up data components for the program through the effective utilization of the hospital medical record systems and through a coordinated effort… more
- Nuvance Health (Poughkeepsie, NY)
- …Team Leaders via program dashboard on quality and process measures.Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as ... *Description* Summary: *Purpose: *The Quality Systems Reviewer assists in the implementation of the Agencyi? 1/2s Performance Improvement, Risk Management, Infection… more
- ManpowerGroup (Columbia, SC)
- …communicate with members and healthcare providers. **Key Responsibilities** ✔ **Medical Review & Utilization Management (80%)** + Perform medical reviews ... ** Utilization Management Nurse / Social Worker (Contract Position)**...Review interdepartmental requests for medical information to support utilization processes. + Conduct high-dollar forecasting and patient health… more
- Centene Corporation (Austin, TX)
- …with ABA, Psychological Testing, Neuropsychological Testing required. Utilization Management experience strongly preferred. **Position Purpose:** Authorize, ... with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or designee, to… more