- Healthcare Recruitment Counselors (Laurinburg, NC)
- …to always provide the most effective method to treat pain. Duties: Takes initial patient histories and performs physical examinations Review patient's medical ... program Physician Assistant /Nurse Practitioner license in NC 2-4 years of clinical work experience Must be willing to work independently and be responsible… more
- The Hartford (Alpharetta, GA)
- …that will perform Utilization Review for Work ers' Compensation Claims. An Initial Clinical Reviewer (ICR) is responsible for evaluating treatment ... future. The Clinical team is seeking an Initial Clinical Reviewer . This is...using nursing judgment, treatment criteria guidelines and Physician Advisor/Peer Clinical Review referral process. Conduct first level… 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
- Evolent Health (Columbus, OH)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer you will be a key member of the utilization management team. ... rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure...guidelines. + Aids and acts as a resource to Initial Clinical Reviewers. + Ensures documentation of… more
- Evolent Health (Columbus, OH)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Oncology, Physician Clinical Reviewer you will be a key member of the utilization management ... well as, aids and acts as a resource to Initial Clinical Reviewers. **What You Will Be...within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure… 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
- UNC Health Care (Chapel Hill, NC)
- …**Key duties for this role will include:** Review of Referrals: Conduct initial clinical review of incoming referrals to assess urgency, appropriateness, ... 9a-5p. The individual hired into this role will be responsible for the clinical review and intake of referrals within the Patient Access Center. This role… more
- Elevance Health (Denver, CO)
- … initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires ... **Nurse Reviewer I** **Location:** Within 50 miles of a pulse point...additional medical necessity review . + Conducts initial medical necessity review … 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
- Kepro (Minneapolis, MN)
- …related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all ... is looking for a Utilization Management - Mental Health Clinical Reviewer to join our growing team....Summary: The purpose of this position is to utilize clinical expertise to review medical records against… more
- Point32Health (MA)
- …**- what you will be doing** **Utilization Management** + Performs clinical review of prospective, concurrent, and retrospective coverage requests ... 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)
- …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
- Kepro (Richmond, VA)
- …related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… 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
- PeaceHealth (Vancouver, WA)
- …knowledge of current Medicare part A and how it impacts DRG assignment to the review of clinical documentation. + Performs other duties as assigned. What You ... PeaceHealth is seeking a RN Clin Doc Integrity Specialist/Denial Reviewer for a Full Time, 1.00 FTE, Day position....denials and appeals management. Performs in depth reviews of clinical DRG downgrade denials to draft appeal letters for… more
- Kepro (NC)
- …Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver ... public sector. Acentra Health seeks a Regional Mentor QA Reviewer (RN - Hybrid) to join our growing team....Summary: The Regional Mentor travels to perform education and initial /re-evaluation assessments of Aged and Disabled Waiver members for… more
- Mount Sinai Health System (New York, NY)
- …Dependency Inpatient Units (subject to assignment by management) and for all aspects of the initial review on an as needed basis Develops rapport with and daily ... information if both documented and available in timely fashion to facilitate initial clinical reviews, pre-certifications and authorizations to admit to… 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
- Sanford Health (Sioux Falls, SD)
- …to case managers by scheduling telephonic visits with members, completing initial clinical screening questionnaire of members, facilitating correspondence with ... team members. Supports medical management programs and operations. Case management leads the initial intake and review of members who are eligible for medical… more
- University of Utah (Salt Lake City, UT)
- …Responsibilities include providing individual, group, relationship counseling, conducting initial consultations, clinical supervision, and crisis intervention ... services. Possession of strong clinical skills, the ability to manage a full client...& Family Therapist ( AMFT ). **Responsibilities** + Provide initial consultations and crisis intervention services. + Conduct individual,… more
