- SOFIE (Totowa, NJ)
- …Responsibilities Develop protocols for the production and analysis of clinical -grade radiopharmaceuticals, validate these methodologies against quality ... Development Specialist Title | Product Development Specialist Location | Remote Department | Radiopharmaceutical Contract Manufacturing (RCM) Pay |… more
- Merck (Sacramento, CA)
- **Job Description** In partnership with the Clinical Quality Operations Lead (CQOL and Head of CQO, the CQOM is accountable for the execution of operational ... and inspection management activities. The CQOM will oversee headquarters clinical quality operations and support clinical...will collectively and periodically (eg quarterly) perform a TA-level review of quality plans and risk mitigation… more
- ChenMed (Miami, FL)
- …to join our team. The Physician Reviewer is the primary physician reviewer for Utilization Management/ Clinical Appropriateness review cases in our ... for our patients. The position will also participate in Process and Quality improvement in our developing area of Delegated Utilization Management. **ESSENTIAL JOB… 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 ... your true colors to blue. The Role 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
- Evolent (Lansing, MI)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- AmeriHealth Caritas (Washington, DC)
- …determinations based on clinical criteria. Using professional judgment, the Clinical Care Reviewer assesses the appropriateness of services, identifies care ... When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines… more
- Ochsner Health (Slidell, LA)
- …surgeries in the hospital. Works closely with Departments to identify opportunities for clinical quality improvement and other special projects as may be ... assumes responsibility for managing all facets of the National Surgical Quality Improvement Program (NSQIP) database which is a nationally validated, risk-adjusted,… 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 ... use of the member's benefit to provide the best quality care. The TeamThe RN Utilization Management Reviewer...with emphasis on utilization management, discharge planning, care coordination, clinical outcomes, and quality of service. +… more
- Zelis (St. Petersburg, FL)
- …a critical role in supporting the quality and integrity of our clinical review processes, providing expert guidance, and contributing to the continuous ... shape who you are. Position Overview The ECR Dispute Reviewer is responsible for conducting comprehensive clinical ...in a healthcare setting, with a strong background in clinical review , utilization management, or quality… more
- Zelis (FL)
- …found and justifying the revised choices of new codes and DRG, based on the clinical evidence obtained during the review + Document all aspect of audits ... interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay… more
- Zelis (St. Petersburg, FL)
- …that shape who you are. Position Overview At Zelis, the Itemized Bill Review Facility Reviewer is responsible for analyzing facility inpatient and outpatient ... proper coding and billing guidelines. They will work closely with Expert Claim Review and Concept Development staff to efficiently identify billing errors and adhere… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the diagnosis and treatment of members' medical health conditions, applying established clinical review criteria, guidelines and medical policies and contractual ... benefits as well as State and Federal Mandates. May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental… more
- Health Care Service Corporation (Chicago, IL)
- …reviews in accordance with the medical contract and regulations, medical criteria, utilization review , and quality of care. **JOB REQUIREMENTS** **:** + LPN with ... valid, current, unrestricted clinical license in the state of operations. + 3...obtain multi-state licenses. **PREFERRED JOB REQUIREMENTS** **:** + Utilization review or utilization management experience **Telecommute:** This is a… more
- Zelis (NJ)
- …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'll do: +… more
- UCHealth (Aurora, CO)
- Description This position is an onsite role and does not offer a hybrid or remote option. UCHealth Clinical Quality and Safety Specialist (CQSS) - Safety * ... review and response Location: UCHealth UCHlth Leprino Building AMC, US:CO:Aurora Department: Clinical Quality FTE: Full Time, 1.0, 80.00 hours per pay period… more
- Martin's Point Health Care (Portland, ME)
- …Summary The Supervisor is responsible for day-to-day operations of the utilization review clinical team, in the areas of authorization requests, organizational ... Board of Managed Care Nursing (ABMCN), National Committee of Quality Assurance (NCQA), Centers of Medicare and Medicaid Services...management experience in a managed care setting including utilization review + RN experience in a clinical … more
- Trinity Health (Davenport, IA)
- …toward the integrity of clinical documentation through the roles of reviewer , educator and consultant. Facilitates the overall quality , completeness and ... accuracy of medical record documentation through extensive record review . **Our Commitment** Rooted in our Mission and Core Values, we honor the dignity of every… more
- Trinity Health (Livonia, MI)
- …and proper documentation requirements as it relates to reimbursement and other clinical data quality management for colleague training. Provides quality ... and quality outcomes. Serves as a resource for appropriate clinical documentation. Responsible for scheduling and staffing assignments for the Clinical… more
- Cedars-Sinai (Beverly Hills, CA)
- …surpluses. Negotiates with sponsors the final payment due for account closeout. May conduct review and/or audits of clinical trial budgets. Serves as a resource ... trial budget. + Performs Medicare coverage analysis for clinical trials and collaborates with Institutional Review ...improve existing standard operating procedures related to budgeting and clinical trials finance. May identify quality and… more
- UTMB Health (Galveston, TX)
- QAPI Clinical Service Ln Mgr (RN) Partial Remote (Sealy Heart & Vasc. Inst. - Galveston) **Galveston, Texas, United States** Nursing & Care Management UTMB ... + Sound working knowledge of concepts, practices, and procedures related to quality improvement functions specific to clinical program supporting. + Demonstrated… more
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