- 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
- Atlantic Health System (Morristown, NJ)
- …process for CMS required patient notices. 8. Completes and documents utilization reviews, physician advisor referrals and other communications related to assigned ... CMS required patient notices and other regulatory requirements within the utilization management process. 10. Maintains proficiency in the application of… 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 (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)
- **JR150009 Genetic Counselor Reviewer ** The genetic counselor reviewer (GCR) is responsible for authorization requests and determining their appropriateness per ... for genetic tests from front-line intake. + Conducting medical necessity review in adherence to guidelines and determining whether clinical information presented… 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
- 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
- Corewell Health (Grand Rapids, MI)
- …partners and major delivery systems. Expectations will include appropriate application of utilization management skills and strategies to assure the right care at ... and lower per-capita costs; participate in the development of clinical utilization guidelines, health management programs and clinical quality programs. + Provide… more
- Centene Corporation (Austin, TX)
- …appeals, and occasional peer-to-peer consultations, as well as participating in Utilization Management clinical rounds.** **We're seeking candidates who:** + **Hold ... with network practitioners to provide education on best practice models and utilization management processes. + Interact with the Medical Director, or designee, to… more
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