- Kepro (CA)
- …regulatory bodies, you'll play a pivotal role in upholding industry benchmarks. This full-time Clinical Reviewer Remote position based in the state of ... solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team...the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process in alignment with the California Mental Health… more
- Marshfield Clinic (Minocqua, WI)
- …together to support the most exciting missions in the world!** **Job Title:** Clinical Integration Technology Analyst ( Remote /Hybrid within MCHS Service ... States of America) **Job Description:** **This position will work remote with onsite support as needed. Individual will need...support as needed. Individual will need to be located within the state of WI.** **Job Description** **JOB SUMMARY**… 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 ... 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
- AmeriHealth Caritas (Philadelphia, PA)
- ** Clinical Care Reviewer , Pediatric Shift Care, Registered Nurse** Location: Philadelphia, PA Primary Job Function: Medical Management ID**: 34518 Your career ... www.amerihealthcaritas.com. **Responsibilities:** Under the direction of the unit Supervisor, the Clinical Care Reviewer - Shift Care is responsible for managing… more
- Kepro (AR)
- …Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver ... in the public sector. Acentra seeks a Dental Hygienist Reviewer to join our growing team. Summary Description The...to join our growing team. Summary Description The Dental Clinical Specialist is responsible for the Utilization Management and… more
- Kepro (Lombard, IL)
- …vital partner for health solutions in the public sector. Acentra seeks an OBGYN Physician Reviewer (PRN, Remote within Illinois) to join our growing team. ... Job Summary: The OB/GYN Physician Reviewer will provide principal leadership and clinical ...stay criteria for IL Medicaid Fee-For-Service beneficiaries. *Position is remote but candidates must reside within the… more
- WTW (Boston, MA)
- …for providing support to United States based Health and Benefits Consultants and Clients. Within this role, as a member of North America client team, you will ... to timeline proactively to Project Manager + Complete initial review of carrier responses for parity projects + Draft...and client specific responses + Collaborate with MHPAEA senior reviewer and Project Manager to conduct follow up calls/emails… more
- Kepro (Lombard, IL)
- …continued stay criteria for IL Medicaid Fee-For-Service beneficiaries. *Position is PRN and remote within the state of Illinois. Job Responsibilities: + Conduct ... in the public sector. Acentra seeks a Psychiatrist Physician Reviewer (Illinois Remote , PRN) to join our...clinical expertise to operations relating to the peer review process, utilization review activities, and other… more
- Kepro (ND)
- …growing team. Job Summary: Our Nurse Clinical Reviewer will use clinical expertise for the review of medical records against appropriate criteria in ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… more
- Kepro (Minneapolis, MN)
- …solutions in the public sector. Acentra is looking for a Utilization Management - Mental Health Clinical Reviewer to join our growing team. This is a Remote ... Summary: The purpose of this position is to utilize clinical expertise to review medical records against...Responsibilities: + Assures accuracy and timeliness of all applicable review type cases within contract requirements. +… more
- Zelis (Morristown, NJ)
- Position Overview: At Zelis, the Itemized Bill Review Facility Reviewer is responsible for analyzing facility inpatient and outpatient claims for Health Plans ... overall claims progression + Complete claims processing after the Clinical Bill Review and Audit analysis is...appeals process as necessary + Collaborate between multiple areas within the department + Evaluate current Quality Assurance Process… more
- SSM Health (MO)
- …as well as the level of services rendered. The CDI Specialist assesses clinical documentation through extensive review of the medical record, interaction with ... **It's more than a career, it's a calling** MO- REMOTE **Worker Type:** Regular **Job Highlights:** At SSM...coding rules and guidelines with follow up reviews. Analyze clinical information to identify areas within the… more
- US Tech Solutions (May, OK)
- Job Title: HEDIS Reviewer II Location: Remote Duration: 7 months Job Description: This position interprets relevant clinical criteria through review of ... 100% of work activities on the computer. Participates in the collection and review of medical records to abstract clinical information for HEDIS quality… more
- City of New York (New York, NY)
- …supervision of the Director of the Evaluation Standards Unit, the Evaluation Reviewer will: Provide quality assurance for the Early Intervention Program by reviewing ... fail to comply with regulatory standards and/or to establish eligibility. Provide clinical expertise and guidance to the Bureau of Early Intervention as it… more
- System One (Copley, OH)
- Title: Medical Reviewer Location: Remote - must be available to work on EST hours Pay Rate: $80+/hr, commensurate with experience Type: contract (renewable) ... selected medical professionals must have recent patient and healthcare experience within the United States. Activities include performing medical reviews of short,… more
- US Tech Solutions (Columbia, SC)
- …benefits or services, and appeals. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and ... equipment to be prepared. + The position is fully remote after that. + Please list out the top...I would love to have someone with prior insurance/utilization review experience, but I know that is not very… more
- Centene Corporation (Madison, WI)
- …zone. CPC or RHIT certification is strongly preferred. **Position Purpose:** Perform clinical /coding medical claim review to ensure compliance with coding ... changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene...practices through a comprehensive review and analysis of medical claims, medical records, claims… more
- Prime Therapeutics (Columbus, OH)
- …and drives every decision we make. **Job Posting Title** Senior Director Operations - Clinical Review - Remote **Job Description** The Senior Director ... responsible for strategic leadership and tactical development of a department within our Clinical Review Operations functional area. The Sr Director… more
- AbbVie (Chicago, IL)
- …standards, and driving those improvements to completion This role has the flexibility to be remote within the US. Qualifications + Education: + MS with 8 years ... define one more of the following types of standards within the assigned therapeutic areas: + Data Collection +...Overseeing the creation of SDTM define.xml, annotated CRF and Clinical Study Data Reviewer 's Guides for FDA,… more
- AbbVie (New York, NY)
- …extensions to CDISC + Oversee the creation of SDTM define.xml, annotated CRF and Clinical Study Data Reviewer 's Guides for both FDA and PMDA submissions. + ... Twitter, Facebook, Instagram, YouTube and LinkedIn. Job Description The Manager, Clinical Data and Reporting Standards (CDARS) proactively participates in the… more