- Adelante (Goodyear, AZ)
- …health outcomes reporting, clinical audits, and programmatic evaluation + Help evaluate clinical care , utilization of resources, and development of new ... more
- US Tech Solutions (Canton, MA)
- …possible extension)** Notes: Fully remote, MA license required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- ... more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …and benefits, as well as regulatory and NCQA requirements. + Refer to RN or PT Clinical Utilization reviewer for more complex cases as appropriate or when ... more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care for members who may have complex healthcare ... more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …the diagnosis and treatment of members' medical health conditions, applying established clinical review criteria, guidelines and medical policies and contractual ... more
- VNS Health (NY)
- OverviewOversees the completion and approval of all clinical utilization documentation, including Start of Care , Re-certification, Resumption of Care , ... more
- Aspen Medical (Aurora, CO)
- …experience in a direct patient care clinical setting. Must have utilization management, utilization review or case management experience for 12 ... more
- AnMed Health (Anderson, SC)
- … Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management programs at ... more
- Centers Plan for Healthy Living (Margate, FL)
- …currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a ... 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 ... more
- Point32Health (MA)
- …day in service to our members, partners, colleagues and communities. **Job Summary** The Clinical Reviewer is a licensed Registered Nurse that is expected to ... more
- Apex Health Solutions (Houston, TX)
- …a contact and resource person to Health Solutions' members for the utilization review (UR) of healthcare services. The UM Reviewer will be responsible for ... more
- CVS Health (Columbus, OH)
- … setting such as ambulatory care or outpatient clinic/facility + Managed care / utilization review experience + Case management and discharge planning ... more
- The Cigna Group (Bloomfield, CT)
- …in Utilization Management. Handles moderately complex medical review , utilization review , credentialing/re-credentialing, quality assurance/improvement, ... 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 ... more
- Corewell Health (Grand Rapids, MI)
- …medicine, and lower per-capita costs; participate in the development of clinical utilization guidelines, health management programs and clinical ... more
- Virtua Health (Marlton, NJ)
- …record to ascertain appropriate documentation, resource utilization , quality of care and cost effectiveness. Provides clinical analysis and oversight of ... more
- Nuvance Health (Poughkeepsie, NY)
- …dashboard on quality and process measures .Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as appropriate. ... more
- Adelante (Surprise, AZ)
- …health outcomes reporting, clinical audits, and programmatic evaluation. + Assist in clinical care by providing utilization of resources, and development ... more
- UPMC (Pittsburgh, PA)
- …healthcare resource utilization , case management interventions. Update the plan of care following review and communicate recommendations to the member and ... more