- Novo Nordisk Inc. (Langhorne, PA)
- …of 1987 and all related Novo Nordisk policies regarding the judicious use of physician samples and stock items Ensure timely and accurate transmission of DCS call ... appropriate use of regional resources to ensure attainment of profitability goals Review and audit expense reports Continuously improve the knowledge of Novo Nordisk… more
- Merck & Co. (North Wales, PA)
- …- These customers may include:- Health care providers such as physicians, physician assistants, nurse practitioners, nurses, pharmacists as well as quality directors ... at product workshops and conferences, as well as consistent and ongoing review of Company promotional materials. Providing Company management with updates on… more
- Novo Nordisk Inc. (Toms River, NJ)
- …Relationships Externally, the DCS I maintain relationships with physicians, physician assistants, nurse practitioners, medical assistants, pharmacists, nurses and ... by not exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records. Qualifications Bachelor's or equivalent degree, and/or Pharm… more
- Novo Nordisk Inc. (Phoenix, AZ)
- …and unique insights Leverages superior understanding of complexities within the targeted physician customer base in order to maximize performance Applies high level ... by not exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records. Qualifications Bachelor's or equivalent degree, and/or Pharm… more
- Novo Nordisk Inc. (Boston, MA)
- …1987 and all related Novo Nordisk policies regarding the judicious use of physician samples and stock items Coaches' representatives to perform against essential job ... by not exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records. Development Of People Supervisory. Ensure that reporting… more
- ChenMed (Miami, FL)
- …The Physician Reviewer is the primary physician reviewer for Utilization Management/Clinical Appropriateness review cases in our organization. Other ... duties include advising other physician reviewers and attending daily calls with health plan...preferred + At least one (1) year of utilization review experience preferred We're ChenMed and we're transforming healthcare… more
- AdventHealth (Maitland, FL)
- …and in collaboration with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality physician ... complexity of care of the patient. The Second Level Reviewer I educates members of the patient care team...(ROM), and quality. + Completes accurate and timely record review to ensure the integrity of documentation compliance. +… more
- HCA Healthcare (Brownsville, TX)
- …want to join an organization that invests in you as a Coding Quality Audit Reviewer ? At Parallon, you come first. HCA Healthcare has committed up to $300 million in ... We are looking for a dedicated Coding Quality Audit Reviewer like you to be a part of our...result in appropriate reimbursement and data integrity. You will review outcomes are communicated to the HSC team to… more
- AdventHealth (Altamonte Springs, FL)
- …and in collaboration with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality physician ... complexity of care of the patient. The Second Level Reviewer I educates members of the patient care team...(ROM), and quality. . Completes accurate and timely record review to ensure the integrity of documentation compliance. .… more
- Hartford HealthCare (Hartford, CT)
- …Island. We consist of a team of professionals ranging from Medical Assistants to Physician Assistants and everything in between. Our physician led medical group ... The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection, documentation,… more
- Elevance Health (Nashville, TN)
- …determining whether clinical information presented meets medical necessity criteria or requires physician review or override. + Clearly and concisely documenting ... **Genetic Counselor Reviewer ** The Genetic Counselor Reviewer (GCR) is...clinical review and other case interactions in online database in adherence… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …expert for member and provider submitted appeals. Working collaboratively with Physician review unit, Utilization Management, Case Management, Member appeals ... regulatory timeframes.The TeamAs an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer ...and accreditation standards and timeframes. + Collaborate with the Physician Review Units to assist with medical… more
- Independent Health (Buffalo, NY)
- …The Clinical Reviewer will be responsible for the collection and review of medical records specific to quality complaints/grievances and appeals as indicated in ... support of a high performing health plan and physician network. The Clinical Reviewer will investigate quality complaints/grievances and appeals, document… more
- Elevance Health (Walnut Creek, CA)
- **Nurse Reviewer I** Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... work weekends if necessary. New Grads are encouraged to apply! The **Nurse Reviewer I** will be responsible for conducting preauthorization, out of network and… 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
- Cook Medical (West Lafayette, IN)
- …is currently accepting applications for a Scientific Communications Medical Reviewer to join our growing Scientific Communications/Clinical team. Medical Reviewers ... provide medical review of documents written by team members who do...with medical device experience preferred; however, nurse practitioners and physician assistants may qualify, depending on training and experience;… more
- Evolent (Austin, TX)
- …clinical guidelines for appropriateness and medical necessity, the request is sent to a physician reviewer . At no time can a URN recommend an adverse ... documentation. + Ensures regulatory guidelines are met for timeliness and use of medical review criteria. + Acts with honor and integrity, serving as a role model… more
- Intermountain Health (Salt Lake City, UT)
- …efforts, coordination of transition of care and manage utilization through appropriate review of authorization requests. Scope As a Utilization Review RN ... need to know how to: + Use nationally recognized review criteria to ensure that patient status is at...necessity. Participate in continued stay reviews. Communicate with attending physician regarding questions about continued length of stay, plan… more
- Centene Corporation (New York, NY)
- …on workplace flexibility. **Position Purpose:** Perform clinical/coding medical claim review to ensure compliance with coding practices through a comprehensive ... review and analysis of medical claims, medical records, claims...in medical billing & coding, coding/data analysis, accounting/business or physician /hospital data management or RN/LPN and 2+ years 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
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