- CHRISTUS Health (Wake Village, TX)
- …to Physician Advisor or CMO when discrepancies are present. * Performs the initial clinical medical necessity review utilizing evidence-based criteria and ... ongoing management of patients in Observation status to include repeated review of clinical and opportunities for conversion to inpatient status. * Works closely… more
- Prime Therapeutics (Columbus, OH)
- …all cases in which clinical determinations cannot be made by the Initial Clinical Reviewer . + Discusses determinations with requesting physicians or ... drives every decision we make. **Job Posting Title** Physician Clinical Reviewer - GI- REMOTE **Job Description Summary**...+ Provides assistance and act as a resource to Initial Clinical Reviewers as needed to discuss… more
- Vanderbilt University Medical Center (Nashville, TN)
- …the trial's overall success. With oversight, serve as a resource for developing the initial Clinical Trial Agreement/Contract between VUMC and the Clinical ... the project's success. TRIAL MANAGEMENT (INTERMEDIATE) + Perform ongoing regulatory review for participating Clinical Trial sites to maintain compliance… more
- AmeriHealth Caritas (Wilmington, DE)
- …Level of Care Redeterminations for home and community based members annually. This requires clinical review when evaluating the need for a member to remain in ... Provide education and routine follow-up with member. + Perform initial clinical assessment of new members, develop...more frequently as needed in accordance with requirements. + Review and acting upon worklists in Jiva, including monitoring… more
- Baptist Memorial (Columbus, MS)
- …work and monitoring their performance. + Takes patient history as required; making initial clinical tests or assessments and referring patient to appropriate ... preventive healthcare services. Responsible for ensuring the proper dispensation, review and verification of prescribed medications within regulatory guidelines,… more
- MicroVention, Inc. (Aliso Viejo, CA)
- …+ Oversee clinical scientists in their support of publication and initial presentation of clinical study and meta-analysis results including timeline ... and Medical Affairs leadership in the development of regulatory strategies and preparation/ review of clinical content to support regulatory submissions. +… more
- Kepro (AR)
- …to the processes and functions as the initial resource to assigned clinical staff regarding all review process questions and/or concerns. + Perform all ... experience. + Experience with State Medicaid Dental programs. + Utilization Management/ Clinical Review experience. #LI-SD1 Why us? We are a team of experienced… more
- Centers Plan for Healthy Living (Margate, FL)
- …for healthy living. JOB SUMMARY: The Grievance & Appeal Clinical Reviewer performs complex medical necessity reviewed on Initial Adverse Determinations or ... RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd,...regulatory requirements including timelines. + Presents recommendations based on clinical review , criteria, and organizational policies +… more
- CaroMont Health (Gastonia, NC)
- …necessity are accurately determined. Refers to physician advisor and /or second level reviewer when necessary. Documents initial review , communications, and ... Job Summary: Completes initial review for medical necessity for...to the UR Specialists on Provider Link. Send corresponding initial clinical and H&P's to commercial companies,… 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 ... and their commitment to our mission is what sets us apart. The Clinical Documentation Improvement (CDI) specialist is responsible for facilitating the improvement in… more
- WMCHealth (Valhalla, NY)
- …+ Reviews inpatient cases when clinical determinations cannot be made by initial clinical review . + Discusses determinations with requesting physicians ... as required to overturn denials. + Provides assistance to initial clinical reviewers as needed to discuss...aggregate denials/appeals with the Medical Director, peer, or the Clinical Review Supervisor. + Provides continuous education… more
- Medical Mutual of Ohio (OH)
- …settings. **Responsibilities** . Determines appropriateness of services and procedures. Manages initial , concurrent, and retrospective review of cases, including ... national decision support criteria, Company policies, individual patient considerations, and clinical judgment. Refers cases that are complex or outside the… more
- Dana-Farber Cancer Institute (Weymouth, MA)
- …Operations. These functions may include, but are not limited to, collecting initial clinical data, collecting demographic and insurance information, providing ... clear and accurate financial information/options, and scheduling the initial visit. Contact with the new patient is the first introduction to the practice, and, as… more
- Merck (South San Francisco, CA)
- …execution of early clinical strategy for novel therapeutics including authoring initial clinical and biomarker plans for Lead Optimization programs, early ... . Translational Medicine at our Research Division is responsible for early clinical development of novel therapeutics, working in close collaboration with Discovery… more
- University of Colorado (Aurora, CO)
- …solving, and staying focused while managing distractions. The clinician will provide clinical services, including initial clinical assessments and ... humility, and action related to DEI topics including systematic review of policies and procedures to ensure they are...Medical Campus Department of Psychiatry. PEACS is a specialized clinical and research program focusing on young people ages… more
- Evolent Health (Columbus, OH)
- …input is needed or required. As well as, aids and acts as a resource to Initial Clinical Reviewers. **What You Will Be Doing:** + Serve as the specialty match ... reviewer in Cardiology cases, that do not initially meet...within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure… more
- Crawford & Company (Los Angeles, CA)
- …certifications. * Must be able to travel as required. * Individuals who conduct initial clinical review possess an active, professional license or ... of practice that is relevant to the clinical area(s) addressed in the initial clinical review . * Must maintain a valid driver's license in state of… more
- University of Utah (Salt Lake City, UT)
- …Responsibilities include providing individual, group, relationship counseling, conducting initial consultations, clinical supervision, and crisis intervention ... $80,000+, depending on licensure and experience **Close Date** **Priority Review Date** **Job Summary** The University Counseling Center (...services. Possession of strong clinical skills, the ability to manage a full client… more
- Parkview North Hospital (Fort Wayne, IN)
- …contact and hand off to assure patient safety during hand off with plan of initial clinical care. Works collaboratively with Point of Entry Case Manager to ... Parkview Health System (excludes L&D, PBH, Ortho Hospital and Rehab/CCC). Performs initial high level assessment to all incoming admission requests, making quick… more
- Dartmouth Health (Lebanon, NH)
- …learning theories and best practice for nursing education. Our work includes initial onboarding, clinical area orientation, competence assessment ( initial ... will facilitate the development of skills in critical thinking, clinical reasoning, effective communication, and interdisciplinary collaboration for D-H nurses.… more
