- Magellan Health Services (Boise, ID)
- …minimal supervision. Project management skills and demonstrated experience. General Job Information Title Quality Clinical Reviewer ( Remote - Must live ... and external reporting. Interacts with multiple stakeholders internally and externally. Provides clinical reviews of Quality of Care (QOC) and Critical/Adverse… more
- Walgreens (Deerfield, IL)
- …1502790BR **Title:** Senior Site Quality & Training Manager, RWE Clinical Trials ( Remote ) **Company Indicator:** Walgreens **Employment Type:** **Job ... and centralized monitoring strategies to support a culture of excellence in clinical research. **Job Responsibilities:** + Oversee site quality control (QC)… more
- Trinity Health (Livonia, MI)
- …Full time **Shift:** **Description:** Trinity Health at Home is seeking an experienced RN remote Clinical Quality Review Specialist with ICD10 HCS-D ... **Trinity Health at Home is seeking an experienced RN Clinical Quality Review Specialist for a remote position** **ICD10 HCS-D certification which is… more
- University of Miami (Hialeah, FL)
- … this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Concurrent Quality Reviewer of our hospital reviews ... CDIs, Coders, Quality , and other relevant multidisciplinary teams. The concurrent inpatient quality reviewer will assign a working DRG, as well as capture… 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...including Core Measure chart abstraction, Stroke & STEMI chart review and coordination; performs concurrent chart reviews & is… 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...Medical Center Bay Area!** **Job Summary and Qualifications** **The Quality Review Nurse position encompasses multiple responsibilities… more
- Magellan Health Services (Honolulu, HI)
- …facilities, develops discharge plans and oversee their implementation. + Performs quality clinical reviews while educating and making appropriate interventions ... Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work...Remote Hawaii Grade 24 Work Experience - Required Clinical Work Experience - Preferred Education - Required Associate… 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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …of the Senior Medical Director of the Physician Review Unit (PRU), the reviewer also provides clinical leadership in other areas of BCBSMA. The physician ... The physician reviewer is responsible for evaluating pre & post-service clinical service requests made by BCBSMA members and providers. The physician reviewer… more
- ManpowerGroup (Columbia, SC)
- …or Counseling. + 2 years of clinical experience plus 1 year in utilization/medical review , quality assurance, or home health, or 3 years of clinical ... to quality , which will align successfully in the organization. **Job Title:** Reviewer III, Medical **Location:** Columbia, SC ( REMOTE ) **Pay Range:** Up to… more
- Point32Health (MA)
- …**- what you will be doing** + **Utilization Management** + Performs clinical review of prospective, concurrent, and retrospective coverage requests for ... and concerns. + Supports the provider inquiry line for peer-to-peer discussions. + Performs clinical review of expedited and standard appeals for all lines of… more
- SSM Health (MO)
- …(CDI) specialist is responsible for facilitating the improvement in the overall quality and completeness of provider-based clinical documentation in the medical ... **It's more than a career, it's a calling** MO- REMOTE **Worker Type:** Regular **Job Highlights:** At SSM...the level of services rendered. The CDI Specialist assesses clinical documentation through extensive review of the… more
- Elevance Health (Grand Prairie, TX)
- …or requires physician review or override. + Clearly and concisely documenting clinical review and other case interactions in online database in adherence to ... **JR139503 Genetic Counselor Reviewer ** The genetic counselor reviewer (GCR)...for authorization requests and determining their appropriateness per designated clinical guidelines, clinical policies, and client rules.… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Your Day to Day : + Conduct pre-certification and concurrent and retrospective clinical review of in-state and out-of-state inpatient cases at acute residential ... Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating...by providers that include treatment goals, interventions, and expected clinical outcomes and that support quality and… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …gather clinical information to support the plan of care. + Monitor clinical quality concerns, make referrals appropriately, identify and escalate quality ... to help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for our Medicare… more
- Medical Mutual of Ohio (OH)
- … review of cases, including appeals, through evaluation of clinical information using established national decision support criteria, Company policies, individual ... **_This is a remote opportunity in Ohio. Note, q_** **_uarterly on-site...mind to more than 1.6 million Ohioans through our high- quality health, life, disability, dental, vision and indemnity plans.… more
- US Tech Solutions (May, OK)
- …Participates in the collection and review of medical records to abstract clinical information for HEDIS quality reporting. Training will be provided prior to ... Job Title: HEDIS Reviewer II Location: Remote Duration: 7...Duration: 7 months Job Description: This position interprets relevant clinical criteria through review of medical records,… more
- Bristol Myers Squibb (Summit, NJ)
- …9 am - 5 pm **Responsibilities:** + Supports all activities for the Quality Operations Investigations group. + Review and approve Site operational investigation. ... + Review and approve Supplemental actions. + Review and approve Impact assessments or Product Quality...unique perspectives in an inclusive culture, promoting diversity in clinical trials, while our shared values of passion, innovation,… more
- ManpowerGroup (Columbia, SC)
- **Utilization Management Nurse / Social Worker (Contract Position)** **Location:** Remote (Must Train Onsite for 1-2 Weeks) - Must Reside Within 3 Hours of Client ... communicate with members and healthcare providers. **Key Responsibilities** ✔ **Medical Review & Utilization Management (80%)** + Perform medical reviews using… more
- Zelis (TX)
- …responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG Quality Assurance reviews in an effort to increase the savings achieved ... records utilizing ICD-10 Official Coding Guidelines, AHA Coding Clinic evidence based clinical criteria and client specific coverage policies. What you will do: +… more
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