- Merck & Co. (St. Louis, MO)
- Job DescriptionRole SummaryThe Regional Medical Scientific Director (RMSD) is a credentialed (ie, PhD, PharmD, DNP, MD) therapeutic and disease expert who engages in ... bidirectional exchange of scientific or medical information with Scientific Leaders (SLs). The role provides balanced, factual, scientific information about… more
- Daiichi Sankyo, Inc. (Bernards, NJ)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... the Oncology Business Unit/US Oncology Business Division (including, for example, Medical Affairs, Sales, Marketing, Market Access, etc.) including, but not limited… more
- Daiichi Sankyo, Inc. (Bernards, NJ)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... Labeling and Pricing Committees and as legal representative on the promotional materials review team for market access team and materials (including, but not limited… more
- Serco (VA)
- …complete review of all medical records received to ensure quality medical review of claims . + Identify opportunities for improvements to streamline ... **Position Description** Serco is seeking a motivated Medical Review Manager to join our...utilization review firm, or another health care claims processing organization involving medical and coding… more
- ConvaTec (South Easton, MA)
- …guideline requirements needed to set up and maintain client accounts of 180 Medical . + Review received documentation to determine insurance requirements are met. ... records within Medtrack, an internal database, to support client services and claim payment processes. + Support Team Supervisor on miscellaneous projects + Must… more
- Takeda Pharmaceuticals (Lexington, MA)
- …to the best of my knowledge. **Job Description** **Senior Manager, US Medical Ad/Promo Regulatory Review ** **Takeda Pharmaceutical** **Lexington, MA or Exton, ... the role:** Join Takeda as a Senior Manager, US Medical Ad/Promo Regulatory Review where you will...comments and any other interactions regarding use of promotional claims for assigned products. + Ensure review … more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- … medical treatment facility, in rehabilitative or occupational nursing or providing medical review of insurance claims . MINIMUM QUALIFICATIONS - ... third party administrator files to oversee contractor handling; + May review medical records of various health care eligibility, resource unit referral and/or… more
- The Arora Group (Bethesda, MD)
- …providers in gathering clinical information and may also provide education on the medical review process. + The Contractor performing as the License Practical ... Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse...and validity of the item(s) supplied in a valid claim through the use of medical policy… more
- US Tech Solutions (Columbia, SC)
- …Utilizes available resources to promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for ... healthcare needs of our members. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying… more
- City of New York (New York, NY)
- …appropriate, negotiate and settle claims within delegated monetary authority level; 8) Review medical providers and law firms to ensure all entities are in ... not limited to: 1) Manage individual No-fault files and review investigation reports, medical reports, bills and...to gather information relevant to the investigation of the claim ; 11) Investigate, identify, and report fraudulent claims… more
- Select Medical (Mechanicsburg, PA)
- …workers' compensation and work-related injury claims filed, manage and monitor claim activity to mitigate liability on future medical and indemnity costs, ... to work for Select Medical .** **Responsibilities** Select Medical is seeking an Employee Safety and Claim...Claim coordinator and reserve monitoring: continually monitor and review reserves on all… more
- Travelers Insurance Company (Independence, OH)
- …This position is responsible for handling Personal and Business Insurance First Party Medical claims from the first notice of loss through resolution/settlement ... you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided...Proactively manages the process to ensure proper payment, (ie review medical bills and medical … more
- Travelers Insurance Company (Orlando, FL)
- …intended to develop skills for investigating, evaluating, negotiating and resolving First Party Medical claims on losses of lesser value and complexity. Provides ... completion of a formal training program to advance to Claim Representative - Auto First Party Medical ...Proactively manages the process to ensure proper payment, (ie review medical bills and medical … more
- Humana (Columbus, OH)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more
- Premera Blue Cross (WA)
- …other contractual exclusion or network structure. + Use clinical expertise to support claims review decisions, including level of care, pricing and complexity ... + Participate in the development, annual review , and approval of company medical review criteria as a member of the Premera Medical Policy Committee. +… more
- Highmark Health (Columbus, OH)
- …purposes of assessing the group's renewal rates and impact on future potential medical claims . And if applicable, completes referral requests for case/care ... Risk Analysis of New and Pre-Screen opportunities + Applies medical review and medical underwriting...For claimants over a specific threshold, or with aberrant medical claims or inconsistent information, performs analysis… more
- MTA (New York, NY)
- …regarding incidents that occur on LIRR & MNR property. + Secure and review medical reports, confirm accident status & authorization for diagnostic testing ... Liability Insurance Program. As an integral member of the claims unit this role will supervise Claim ...and hire specialists to assist in the defense of claims (ie: Engineering firms, medical experts, special… more
- Medical Mutual of Ohio (OH)
- …the continuum of care. **Responsibilities** + Independently evaluates basic to complex medical claims and/or appeal cases and associated records by applying ... stay and level of care + Extrapolates and summarizes medical information for physician review or other...terminology and managed care processes + Familiarity with clinical claim management including ICD 10, CPT, HCPC, and revenue… more
- The County of Los Angeles (Los Angeles, CA)
- …direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of ... for and the effective conduct of the system to review patients' medical charts to ascertain the...complete this questionnaire completely and correctly. The experience you claim in this supplemental questionnaire must be consistent with… more
- Sharp HealthCare (San Diego, CA)
- …and outcomes studies as directed by the Quality Management + Committee, Peer Review Committee and Chief Medical Officer and reports findings in conjunction ... Director. + Assists in POS/PPO Case Management and high-cost review with CMO and Claims management teams....+ Able to manage difficult peer situations arising from medical care review . + Appreciation of cultural… more
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