- Molina Healthcare (Phoenix, AZ)
- …programs/processes and member/provider outreach initiatives. + Supports provision of high- quality clinical care and services by facilitating/building strategic ... **JOB DESCRIPTION** **Job Summary** Molina's Quality Improvement function oversees, plans, and implements new...analytics and strategic teams to deliver proposed interventions for review and evaluation. + Communicates with the Molina Plan… more
- University of Miami (Hialeah, FL)
- … this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Concurrent Quality Reviewer of our hospital reviews ... CDIs, Coders, Quality , and other relevant multidisciplinary teams. The concurrent inpatient quality reviewer will assign a working DRG, as well as capture… more
- Magellan Health Services (Baton Rouge, LA)
- …conducting utilization management according to medical necessity criteria. General Job Information Title Clinical Reviewer III (ECSS), Remote in LA Grade 26 ... family engagement, and system-level collaboration with other child-serving agencies. The Clinical Reviewer will support the implementation and ongoing oversight… more
- Adecco US, Inc. (Minneapolis, MN)
- Adecco Healthcare and Life Sciences is currently recruiting for Remote Clinical Quality LPNs with HEDIS experience. This is a telecommute role. Please read ... 5PM EST/CST **Start Date:** August 4 **Primary Responsibilities:** * Remote data mining in EHR systems to support HEDIS...or EHR navigation * 2+ years of medical chart review /data analysis experience * Strong written and verbal communication… 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 ... for managing a clinically complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical… 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 ... **JR150009 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
- Centene Corporation (Frankfort, KY)
- …benefits including a fresh perspective on workplace flexibility. **Centene is Hiring: Remote Psychologist Reviewer (ABA) - Kentucky Market** **Join Centene's ... changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene...mission-driven team as a Remote Psychologist Reviewer specializing in Applied Behavior… more
- St. George Tanaq Corporation (Little Rock, AR)
- Dispute Resolution Reviewer III Fully Remote *GA Job Type Full-time Description **Overview** Tanaq Support Services (TSS) delivers professional, scientific, and ... **About the Role** We are seeking a **Dispute Resolution Reviewer III (DRR III)** to support a contract with...years of medical dispute resolution or Medicare appeals, medical review , clinical , or related experience in a… more
- The Joint Commission (Oakbrook Terrace, IL)
- …Field Representatives, with minimal direction or supervision, survey and/or review health care organizations throughout the United States. Field Representatives ... **Responsibilities** Position Accountabilities: + Ability to analyze and synthesize survey/ review findings to provide conclusions, recommendations and educational opportunities.… more
- Centene Corporation (Austin, TX)
- …your clinical expertise in a non-direct care role, supporting quality care and outcomes for the Medicaid population.** **Position Purpose:** Authorize, direct ... 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,… more
- ManpowerGroup (Columbia, SC)
- **Utilization Management Nurse / Social Worker (Contract Position)** **Location:** Remote (Must Train Onsite for 1-2 Weeks) - Must Reside Within 3 Hours of Client ... communicate with members and healthcare providers. **Key Responsibilities** ✔ **Medical Review & Utilization Management (80%)** + Perform medical reviews using… more
- Actalent (Minneapolis, MN)
- Description Your main role will be utilizing your clinical skills to complete utilization management reviews (Prior authorizations, Coverage Exceptions, Quantity ... team of your peers and other pharmacy professionals. * Quality and performance are measured by monthly quality...or feedback to drive results. 4. Ability to make clinical decisions independently 5. Flexibility to change and resourceful… more
- Actalent (Eagan, MN)
- Description Your main role will be utilizing your clinical skills to complete utilization management reviews (Prior authorizations, Coverage Exceptions, Quantity ... team of your peers and other pharmacy professionals. * Quality and performance are measured by monthly quality...or feedback to drive results. * Ability to make clinical decisions independently * Flexibility to change and resourceful… more
- WTW (Boston, MA)
- …issues or impact to timeline proactively to Project Manager + Complete initial review of carrier responses for parity projects + Map carrier responses to appropriate ... and client specific responses + Collaborate with health management senior reviewer and Project Manager to conduct follow up calls/emails with carriers/vendors… more
- Zeiders Enterprises, Inc (Norfolk, VA)
- Description Job Title: Remote Clinical Counselor **This position is fully remote and able to be supported from any location. However, candidates must be ... regardless of their location.** Shift: 7:00AM-5:30PM ET Summary The Remote Clinical Counselor works as a full-time...zone of the Sailor's location. + Participate in quarterly quality assurance procedures to ensure that all clinical… more
- Zeiders Enterprises, Inc (Norfolk, VA)
- Description Job Title: Remote Clinical Counselor Floater Summary The Remote Clinical Counselor Floater works as a full-time employee of Zeiders ... and Family Support Program (FFSP) Global Staffing Contract. The Remote Clinical Counselor Floater will also carry...suicidal or homicidal risk. + Participate in regional quarterly quality assurance procedures to ensure that all clinical… more
- AbbVie (Chicago, IL)
- …as needed. + Provide review and analysis of safety-related data from clinical trials for content, quality , potential study level trend identification, and ... to achieve its mission of evaluating and ensuring the quality of clinical trial patient safety data...patient safety data by consistent and accurate delivery of high- quality relevant and timely data review . Contributes… more
- Cedars-Sinai (Beverly Hills, CA)
- …surpluses. Negotiates with sponsors the final payment due for account closeout. May conduct review and/or audits of clinical trial budgets. Serves as a resource ... trial budget. + Performs Medicare coverage analysis for clinical trials and collaborates with Institutional Review ...improve existing standard operating procedures related to budgeting and clinical trials finance. May identify quality and… more
- Walgreens (Deerfield, IL)
- **Job Description:** **Job Summary** The Director, Clinical Quality Assurance Management for the RWE Clinical Trial business will be responsible for the ... review and maintain tracking of incidents within the clinical trials, advising on CAPAs to be implemented and...CFR and ICH guidelines + Significant experience with managing clinical quality activities and in-depth knowledge of… more
- Walgreens (Deerfield, IL)
- …\#LI-TO1 **Job ID:** 1515622BR **Title:** Director, Site Management Operations, Clinical Trials ( Remote ) **Company Indicator:** Walgreens Boots Alliance ... (SMO) will be responsible for the enterprise wide implementation and management of clinical trial sites across our community pharmacy network. This member of the… more
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