- Luminis Health (Annapolis, MD)
- …responsible for any charges incurred by the recipient. Candidates are encouraged to review their mobile carrier's plan for applicable text messaging rates and ... develop individualized problem lists for assigned patients. Develops and individualizes a plan of care for each patient in accordance with established standards,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …as appropriate. At the request of the Senior Medical Director of the Physician Review Unit (PRU), the reviewer also provides clinical leadership in other areas ... your true colors to blue. The Role The Physician Reviewer is responsible for evaluating pre & post-service clinical...of the requested service is appropriate, as determined by plan benefit design, plan riders, and medical… more
- LA Care Health Plan (Los Angeles, CA)
- Physical Accessibility Review Survey Reviewer II Job Category: Clinical Department: Facility Site Review Location: Los Angeles, CA, US, 90017 Position Type: ... - $68,474.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created by the...to achieve that purpose. Job Summary The Physical Accessibility Review Survey (PARS) Reviewer II is responsible… more
- Healthfirst (NY)
- **Duties/Responsibilities:** + The Medical Peer Reviewer will assess/ review requests for authorization, and claims payment, based on medical records and internal ... informed clinical judgments and recommendations. + The Medical Peer Reviewer will render determinations in the format and within...for Paid Time Off (PTO) and is required to plan and schedule time off with their direct supervisor… more
- Maryland Department of Transportation (Baltimore City County, MD)
- Shop Drawing Reviewer (Transportation Engineering Technician V) Salary $62,220.00 - $96,790.00 Annually Location Baltimore City Job Type Full Time Job Number ... Questions Description (Open Recruitment) State Highway Administration Shop Drawing Reviewer (Transportation Engineering Technician V) Grade 15 (8450) SP#26-61.2-01… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas ... your true colors to blue. The Role The Physician Reviewer is responsible for evaluating clinical service requests made...anticipatory case management for members whose cases come for review , in partnership with case managers + Participate in… more
- State of Massachusetts (Boston, MA)
- The MassDOT Bridge Technical Review Unit is looking for a Bridge Technical Reviewer . This position will be responsible for the review of all bridge projects ... Bridge Division, and the Designer. This role oversees the review and approval of the bridge design process from...projects across the Commonwealth. *Position Summary* The Bridge Technical Reviewer will oversee the bridge design process for bridges… more
- AECOM (Sacramento, CA)
- …**Job Description** **AECOM** is seeking an **Assistant Project Manager - Utility Design Reviewer ** to work **remotely** . The client is located in Sacramento, CA ... of Investigation ("ROI") and the Utilities Senior Project Manager, the Utility Design Reviewer contributes alongside a team of Utility Design Reviewers to prepare, … more
- Centers Plan for Healthy Living (Margate, FL)
- Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and ... of the fastest growing Managed Long-Term Care company in New York, Centers Plan For Healthy Living is currently accepting applications for Full Time Registered Nurse… more
- AmeriHealth Caritas (Washington, DC)
- …When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines ... on clinical criteria. Using professional judgment, the Clinical Care Reviewer assesses the appropriateness of services, identifies care coordination opportunities,… more
- Dana-Farber Cancer Institute (Brookline, MA)
- Reporting to the Director of Billing Compliance, the Senior Billing Compliance Reviewer will be responsible for the identification and performance of Billing ... Compliance inpatient and ambulatory activities. The Senior Reviewer will assist in the development and execution of...development and execution of the annual Billing Compliance work plan . They will monitor federal and state regulatory requirements… more
- MyFlorida (Tallahassee, FL)
- …No: 860147 Agency: Division of Emergency Management Working Title: OPS PA Programmatic Reviewer - 31902145 Pay Plan : Temp Position Number: 31902145 Salary: ... OPS PA Programmatic Reviewer - 31902145 Date: Dec 21, 2025 The...FDEM prepares and implements a statewide Comprehensive Emergency Management Plan , routinely conducts extensive exercises to test state and… more
- Robert Half Finance & Accounting (Woodbridge, NJ)
- …season. A specialized tax preparation firm in the Woodbridge area seeks a Tax Reviewer to handle the review of individual (1040) tax returns. This opportunity ... is unique because the Tax Reviewer can work flexible hours four days per year...are also eligible to enroll in our company 401(k) plan . Visit roberthalf.gobenefits.net for more information. (C) 2025 Robert… more
- Sharp HealthCare (San Diego, CA)
- …for the medical direction of Authorization Review for Sharp Health Plan (SHP). The Physician Reviewer will perform all reasonably necessary functions ... **Facility:** Health Plan **City** San Diego **Department** **Job Status** Per...of managed care and the process for prior authorization review . + California Physicians and Surgeons License - Medical… more
- Zelis (St. Petersburg, FL)
- …maintain claim review content, including but not limited to DRG Reviewer Rationales, DRG Clinical Validation Policies and Dispute Rationales + Perform regulatory ... are. Position Overview At Zelis, the DRG Clinical Dispute Reviewer role is responsible for the resolution of facility...production and quality metric goals. What you'll do: + Review provider disputes for DRG Coding and Clinical Validation… more
- System One (Andover, MA)
- Job Title: Quality Assurance Batch Record Reviewer I Location: Andover, MA Hours/Schedule: Monday-Friday, 8 am to 5 pm Type: Contract Overview The Quality Assurance ... Batch Record Reviewer I is an entry-level, floor-based QA role supporting...QA role supporting manufacturing operations through real-time batch record review and GMP oversight. This position works directly in… more
- System One (Indianapolis, IN)
- Job Title: QC Microbiology Data Reviewer and Writer Location: Indianapolis, IN Hours/Schedule: Monday - Friday, Business Hours Type: Contract Overview Leading ... pharmaceutical company looking for an experienced QC Microbiology Data Reviewer . Ideal candidates should have 4 years of experience in GMP Microbiology laboratory… more
- Carle Health (Peoria, IL)
- …Arts (LPHA) authorizing Integrated Assessment and Treatment Plans. Will complete thorough review of each document, provide clinical guidance to team members, and ... ensure compliance with IATP standards. LPHA reviewer provides behavioral health assessment, intervention, and consultation to...provide clinical guidance to others. Has the ability to plan and organize their work. Is able to recognize… more
- ChenMed (Miami, FL)
- …join our team. The Physician Reviewer is the primary physician reviewer for Utilization Management/Clinical Appropriateness review cases in our organization. ... other physician reviewers and attending daily calls with health plan teams and our local teams assisting with this...preferred + At least one (1) year of utilization review experience preferred **PAY RANGE:** $198,797 - $283,995 Salary… more
- Verdantas (Wilmington, DE)
- …to shape the future of resilient communities?** Join us as a **Land Development** ** Plan Reviewer Engineer I** , in our **Wilmington, DE** office and help ... bring thoughtful, sustainable development to life! This is a unique opportunity to gain experience in reviewing land development, stormwater management, and erosion control plans for our Municipal clients. You'll work alongside experienced engineers and… more
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