- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Tuesday, November 5, 2024 Centers Plan for Healthy Living's ... plans they need for healthy living. JOB SUMMARY: The Grievance & Appeal Clinical Reviewer performs complex medical necessity reviewed on Initial Adverse… more
- Centers Plan for Healthy Living (Margate, FL)
- UM Clinical Reviewer 5297 W Copans Rd, Margate,...of members' care /social needs, developing a "living care plan " that is modified as needed, working ... healthy living. One of the fastest growing Managed Long-Term Care company in New York, Centers Plan ...Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team… more
- HCA Healthcare (Nashville, TN)
- …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Clinical Reviewer with Parallon you can be a part of an organization ... in our organization. We are looking for an enthusiastic Clinical Reviewer to help us reach our...reviewing medical records for medical necessity in a managed care , health plan , and/or hospital setting +… more
- HCA Healthcare (Webster, TX)
- …Lake we support our colleagues in their positions. Join our Team as a(an) RN Clinical Reviewer and access programs to assist with every stage of your career. ... certifications and job skills. Apply today for our RN Clinical Reviewer opening and continue to learn!...90 days of hire date) + Three year's recent clinical experience in an Acute Care Stroke/Neuroscience… more
- HCA Healthcare (Houston, TX)
- …environment where diversity and inclusion thrive? Submit your application for our RN Clinical Reviewer opening with HCA Houston Healthcare Northwest today and ... may vary by location._ We are seeking a(an) RN Clinical Reviewer for our team to ensure...90 days of hire date) + Three year's recent clinical experience in an Acute Care Stroke/Neuroscience… more
- HCA Healthcare (Brownsville, TX)
- …Center we support our colleagues in their positions. Join our Team as a(an) RN Clinical Reviewer and access programs to assist with every stage of your career. ... may vary by location._ We are seeking a(an) RN Clinical Reviewer for our team to ensure...90 days of hire date) + Three year's recent clinical experience in an Acute Care Stroke/Neuroscience… more
- HCA Healthcare (Corpus Christi, TX)
- …step in your career path, we encourage you to apply for our Registered Nurse Clinical Reviewer opening. We review all applications. Qualified candidates will ... you have the career opportunities as a(an) Registered Nurse Clinical Reviewer you want in your current...and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. +… more
- Prime Therapeutics (Columbus, OH)
- …fuels our passion and drives every decision we make. **Job Posting Title** Physician Clinical Reviewer - GI- REMOTE **Job Description Summary** Key member of the ... clinical determinations cannot be made by the Initial Clinical Reviewer . + Discusses determinations with requesting...as needed to discuss cases and problems. + Utilizes medical/ clinical review guidelines and parameters to assure… more
- Magellan Health Services (Baton Rouge, LA)
- …other clinical staff. + Provides training, interpretation and support for QI Clinical Reviewer staff. + Audits and validates internal audit results and/or ... or more years of experience post degree in a clinical , psychiatric and/or substance abuse health care ...according to medical necessity criteria. General Job Information Title Clinical Reviewer III (Baton Rouge, LA or… more
- HCA Healthcare (Kingwood, TX)
- **Description** **Introduction** Do you have the career opportunities as a(an) RN Clinical Reviewer you want in your current role? We invest in what matters most ... and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. +...**Job Summary and Qualifications** We are seeking a RN Clinical Reviewer for our facility to ensure… more
- HCA Healthcare (Corpus Christi, TX)
- …step in your career path, we encourage you to apply for our Registered Nurse Clinical Reviewer PRN opening. We review all applications. Qualified candidates ... you have the career opportunities as a(an) Registered Nurse Clinical Reviewer PRN you want in your...and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.** +… more
- Pfizer (Collegeville, PA)
- The Clinical Data Reviewer (CDR) is highly specialized to perform clinical data review , most often in a submission timeline. The studies supported by the ... RESPONSIBILITIES + The CDR is routinely responsible for the clinical data review of one or more...position is eligible for participation in Pfizer's Global Performance Plan with a bonus target of 15.0% of the… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The Clinical Pharmacist Reviewer reviews formulary exception, prior authorization and quantity ... Participation in Prior Authorization, Formulary Exception, Step Therapy and Quality Care Dosing program implementation and management. + Support Pharmacy Operations… more
- Centers Plan for Healthy Living (Garden City, NY)
- …supporting the overall direction, coordination and implementation of the HEDIS Medical Record Review process for Centers Plan for Healthy Living (CPHL) under the ... HEDIS Reviewer 990 Stewart Ave, Garden City, NY 11530,...coordination of outreach efforts to request, collect, and secure clinical documentation from Primary Care Physician (PCP)… more
- Carle (Urbana, IL)
- …Arts (LPHA) authorizing Integrated Assessment and Treatment Plans. Will complete thorough review of each document, provide clinical guidance to team members, ... Licensed Practitioner of the Healing Arts (LPHA) Reviewer + Department: Cert Comm BH Clinic -...clinical guidance to others. Has the ability to plan and organize their work. Is able to recognize… more
- The Cigna Group (Bloomfield, CT)
- Performs peer review and case management activities. Delivers clinical expertise to the organization through peer review , decision making, training, ... on clinical practices. **RESPONSIBILITIES INCLUDE:** + Performs clinical and administrative peer review and appeals,...clinical guidelines training. + Serves as mentor/coach to Care Managers, Clinical Managers, Providers and other… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …healthcare? Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care for members who may have complex ... Your Day to Day : + Conduct pre-certification and concurrent and retrospective clinical review of in-state and out-of-state inpatient cases at acute residential… more
- Medical Mutual of Ohio (OH)
- …discharge planning activities based on the members' specific clinical condition, health plan benefits, and optimal care delivery. Acts as a resource to the ... fundamental concepts related to HIPAA compliance and related regulations. + Knowledge of clinical practices and efficient care delivery processes. + Ability to… more
- Sharp HealthCare (San Diego, CA)
- …the direction of the Senior Medical Director or designee for Sharp Health Plan (SHP). The Physician Reviewer will perform all reasonably necessary functions ... **Facility:** Health Plan **City** San Diego **Department** **Job Status** Per...primary care physician with knowledge of managed care and the process for prior authorization review… more
- El Paso County (Colorado Springs, CO)
- Utilization Reviewer - Behavioral Health Print (https://www.governmentjobs.com/careers/elpasocountyco/jobs/newprint/4719458) Apply Utilization Reviewer - ... Provides oversight of services, support, and placement for clients in congregate care placement settings, which include high levels of placements for youth in… more