- Altru Health (East Grand Forks, MN)
- …initiating and participating in restructuring of current and new programs. Performs utilization review when required. Collaborates with Primary Care Provider ... (PCP) regarding the patient's progress and changing needs. Performs other duties as assigned or needed to meet the needs of the department/organization. Certification: Licensed Clinical Social Worker (LCSW) | North Dakota Board of Social Work Examiners | Prior… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …us transform healthcare? Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care for members who may have ... personas: eWorker, mobile and resident. The Team The Clinical Utilization Reviewer is part of a highly...: + Conduct pre-certification and concurrent and retrospective clinical review of in-state and out-of-state inpatient cases at acute… more
- Wellpath (Fort Lauderdale, FL)
- …and point of care support. **How you make a difference** The Utilization Review Coordinatorwill perform admission and continued-stay reviews. This position ... care setting, preferably inpatient preferred. + Minimum one (1) year clinical or utilization review or case management preferred. + Knowledge of managed care… more
- MetroHealth (Cleveland, OH)
- …Milliman Health Management Guidelines. Current working knowledge of, utilization management, case-management, performance improvement, and managed care ... racial, and socioeconomic backgrounds Preferred: 3 years of experience with a Utilization Management focus. Working knowledge of current utilization management,… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas ... help us transform healthcare? Bring your true colors to blue. The Physician Reviewer is responsible for evaluating clinical service requests made by BCBSMA members… more
- Prime Therapeutics (Columbus, OH)
- … Reviewer - GI- REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests ... medical/clinical review guidelines and parameters to assure consistency in the MD review process so as to reflect appropriate utilization and compliance with… 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. ... Services, LLC,** a Koniag Government Services company **,** is seeking a Document Reviewer Level 5 (DRL5) with Top- Secret clearance to support **KPS** and our… more
- Kepro (AR)
- …based on review of clinical records. Preferred Qualifications/Experience: + Utilization Review / Utilization Management experience. + Clinical quality ... for health solutions in the public sector. Acentra is looking for a Clinical Reviewer - Behavioral Health - PRN (Remote within Arkansas) ** The selected candidate… more
- Koniag Government Services (Germantown, MD)
- …Professional Services,** a Koniag Government Services company, is seeking a Document Reviewer Level 2 (DRL2) with a Top-Secret clearance to support **KPS** and ... Services, a Koniag Government Services company, is seeking an experienced Document Reviewer Level 2 (DRL2) to conduct classification reviews of documents and… more
- Koniag Government Services (Germantown, MD)
- …Professional Services,** a Koniag Government Services company, is seeking a Document Reviewer Level 1 (DRL1) with a Top-Secret clearance to support **KPS** and ... Services, a Koniag Government Services company is seeking an entry-level Document Reviewer Level 1 (DRL1) to conduct classification reviews of government agency… more
- Kepro (AR)
- …partner for health solutions in the public sector. Acentra seeks a Dental Hygienist Reviewer to join our growing team. Job Summary: The Dental Hygienist Reviewer ... of dental health policy and preventative treatment plans. The Dental Hygienist Reviewer will complete their work with limited supervision. *Position is remote within… 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
- Elevance Health (San Juan, PR)
- …providing information technology and business operations services for health plans._ **Nurse Reviewer I** **Location:** This position will work a hybrid model (1-2 ... US States time zones that the unit will be supporting. The **Nurse Reviewer I** is responsible for conducting preauthorization, out of network and appropriateness of… more
- ManpowerGroup (Columbia, SC)
- …" to join one of our Fortune 500 clients. **Job Summary** The Medical Review and Utilization Management Specialist is responsible for performing medical reviews ... **Title: Medical Reviewer ** **Location:** **4101 Percival Road Columbia SC 29229...using established criteria and conducting utilization management of professional, inpatient, outpatient, or facility benefits/services,… more
- Koniag Government Services (Germantown, MD)
- …Professional Services,** a Koniag Government Services company, is seeking a Document Reviewer Level 3 (DRL3) with a Top-Secret clearance to support **KPS** and ... Services, a Koniag Government Services company, is seeking an experienced Document Reviewer Level 3 (DRL3) to conduct classification reviews in accordance with… more
- Medical Mutual of Ohio (OH)
- …and individual plans. Under limited supervision, the Medicare Nurse Reviewer applies medical necessity guidelines in making authorization determinations for ... home. We are looking for applicants that have a strong clinical utilization management background. Medicare experience is a plus. **Responsibilities** + Evaluates… more
- Trinity Health (Livonia, MI)
- …Part time **Shift:** Rotating Shift **Description:** **JOB SUMMARY** The Clinical Nurse Reviewer 's chief responsibility is to collect and submit reliable data on ... database of all eligible cases for the hospital. The Clinical Nurse Reviewer also works closely with the physician champion and appropriate hospital leadership… more
- Sharp HealthCare (San Diego, CA)
- …**What You Will Do** The position is responsible for the performing medical utilization reviews and appeals and grievance reviews under the direction of the Senior ... Medical Director or designee for Sharp Health Plan (SHP). The Physician Reviewer will perform all reasonably necessary functions to ensure quality of care and… more
- RWJBarnabas Health (Newark, NJ)
- …Ctr, 201 LYONS AVENUE, NEWARK, NJ 07112-2027 JobTitle:Clinical Reviewer Location:Newark Beth Israel Req#:0000156276 Status:Full-Time Shift:Day Department ... name:Bariatric Practice Job Overview: The On Site Bariatric Data Reviewer /Administrative Coordinator is primarily responsible for the collection and submission of… more
- Hartford HealthCare (Hartford, CT)
- …and more than 30 different specialties. *_ Job Description_* The Surgical Clinical Reviewer 's (SCR) chief responsibility is to collect and submit reliable data to ... multiple time intervals over the course of the patient's care through effective utilization of the hospital and surgeons' office record systems. . Works in… more
