- CVS Health (Columbus, OH)
- …to make health care more personal, convenient and affordable. **Position Summary** The Care Plan Reviewer ( Clinical Case Manager BH) utilizes ... Independent BH Clinical License: LPCC, IMFT, or LISW + Managed care /utilization review experience + Case management and discharge planning experience… more
- US Tech Solutions (Columbus, OH)
- …**Duration: 03 months(Possible FTE)** **Tentative Start Date-:** **12/22/2024** **Responsibility:** + The Care Plan Reviewer ( Clinical Case Manager ... child-serving systems. + Assessment of Members: + Through the use of clinical tools and information/data review , conducts comprehensive assessments of referred… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for our Medicare Advantage members ... Hours of work: 8:30a - 4:30p EST. The TeamThe Clinical Utilization Reviewer is part of a...to gather clinical information to support the plan of care . + Monitor clinical… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …therapists, and facilities as needed to gather clinical information to support the plan of care . + Monitor clinical quality concerns, make referrals ... healthcare? Bring your true colors to blue. The RoleThe Clinical Care Manager is responsible for facilitating...regulatory standards to create, follow and appropriately document comprehensive care management plans. + Review medication list… 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 (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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …healthcare providers and facilities as needed to gather clinical information to support the plan of care and perform the MSK review . + Monitor ... Bring your true colors to blue. The RoleThe MSK Clinical Utilization Reviewer - LPN is responsible...sites of service to develop a cost-effective, medically necessary plan of care . + Pass annual InterQual… 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
- HCA Healthcare (Sun City Center, FL)
- …your career path, we encourage you to apply for our RN Quality Coordinator Clinical Reviewer opening. We review all applications. Qualified candidates will ... have the career opportunities as a(an) RN Quality Coordinator Clinical Reviewer you want in your current...to three (3) years recent experience within an acute clinical practice or related health care position.… more
- HCA Healthcare (Pasadena, TX)
- …HCA Houston Healthcare Southeast! **Job Summary and Qualifications** We are seeking a RN Clinical Reviewer for our facility to ensure that we continue to provide ... and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. +...your career! We are interviewing candidates for our RN Clinical Reviewer opening. Apply today and a… more
- Martin's Point Health Care (Portland, ME)
- …a "Great Place to Work" since 2015. Position Summary Job Description The HEDIS Reviewer and Auditor - Health Plan is responsible for conducting comprehensive ... Join Martin's Point Health Care - an innovative, not-for-profit health care...records, and verifying compliance with HEDIS standards. The HEDIS Reviewer and Auditor - Health Plan collaborates… more
- Bon Secours Mercy Health (Greenville, SC)
- …patient records as the program's dedicated data collector and bariatric surgical clinical reviewer . This position collects, compiles, abstracts, and enters data ... improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas of BCBSMA. The ... healthcare? Bring your true colors to blue. The Physician Reviewer is responsible for evaluating clinical service...anticipatory case management for members whose cases come for review , in partnership with case managers + Participate in… 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
- Apex Health Solutions (Houston, TX)
- …in alternative care placements incompliance to the applicable managed care plan or certified workers' compensation network benefit coverage requirements ... resource person to Health Solutions' members for the utilization review (UR) of healthcare services. The UM Reviewer...coverage or UR questions or issues arise. To support care management initiatives, the UM Reviewer should… 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 ... Day to Day : + Conduct pre-certification and concurrent and retrospective clinical review of in-state and out-of-state inpatient cases, residential treatment… more
- HCA Healthcare (Nashville, TN)
- …invested over 156,000 hours volunteering in our communities. As a Coding Quality Audit Reviewer with Work from Home you can be a part of an organization that ... and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. +...resources for emotional, physical and financial wellbeing + 401(k) Plan with a 100% match on 3% to 9%… more
- Magellan Health Services (Honolulu, HI)
- …solutions that directly influence quality of care . General Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work Experience ... specific utilization problems, plan and implement...- Required CEAP - Certified Employee Assistance Professional - Care Mgmt, LCSW - Licensed Clinical Social… more