- Merck & Co. (North Wales, PA)
- Job DescriptionResponsibilities:Utilize big data to analyze the safety and efficacy claims of potential medical breakthroughs. Review the quality and ... reliability of clinical studies using deep scientific knowledge, statistical analysis and high-quality data to support decision making in clinical trials.Support statistical programming activities for Early Oncology clinical development projects.Responsible… more
- Merck & Co. (North Wales, PA)
- …to the Director/Senior Director in the Office of Promotion and Advertising Review (OPAR)The Associate Director is responsible for the review and ... and serving as the promotional regulatory expert with marketing, legal, and medical teams to ensure that promotional practices are consistent with regulatory… 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 ... one or more clinical study programs which may include review of vendors agreements and policies, external training materials...supervision to: (1) to respond and defend subject injury claims made against the company, and (2) assist cross… 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
- Merck & Co. (North Wales, PA)
- …big data to analyze the safety and efficacy claims of our potential medical breakthroughs. We review the quality and reliability of clinical studies using ... to enable the discovery, development, regulatory approval, manufacturing, and marketing of medical drugs and vaccines for the benefit of patients and global human… more
- Eisai, Inc (San Francisco, CA)
- At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides to patients, their families, and caregivers is Eisai's human health care ... oral markets with approved indications, helping targeted customers, such as Medical Oncologists, Hematologists, Endocrinologists, and nurses, etc. learn about the… more
- Eisai, Inc (Louisville, KY)
- At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides to patients, their families, and caregivers is Eisai's human health care ... oral markets with approved indications, helping targeted customers, such as Medical Oncologists, Hematologists, Endocrinologists, and nurses, etc. learn about the… more
- ManpowerGroup (Columbia, SC)
- …compliance and ensure ongoing process improvement. **Qualifications:** + Strong understanding of medical claims review processes, medical necessity ... **Job Title: Medical Claims Reviewer** **Pay Rate:23/Hr (REMOTE...Ensure thorough documentation of each determination for utilization or claims review . + Review first-level… more
- Actalent (Omaha, NE)
- … claims and preauthorization processing. This role involves accurate and timely medical review of claims , preauthorizations, and customer service ... and preauthorization processing. + Perform accurate and timely medical reviews of claims and preauthorizations. +...medical policy. + Verify member eligibility prior to medical review . + Foster constructive relationships with… more
- Houston Methodist (Baytown, TX)
- …to department specifications. + Manages utilization management (UM) programs including Medical Claims Review , Precertification and Reconsiderations and ... and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and exceed service-level goals… more
- Elevance Health (Norfolk, VA)
- …through normal channels. + Works with internal business partners (sales, member experience, claims , medical review , appeals, etc.) and external contacts ... to Plan emails and Blue 2 General inquiries. + Requests and routes medical records to medical review units. + Keys, processes and adjusts claims for all… more
- Amazon (Seattle, WA)
- …for vendor solutions and benefit programs. - Develop models and pricing analysis for medical outlier claims . - Review and recommend plan designs, plan ... producing clear and effective writing that informs and persuades - Experience with medical claims data (eg, DRG, CPT, ICD-10 diagnosis codes , etc.) - Associate… more
- Lincoln County (Newport, OR)
- …who is reliable with a strong attention to detail. The person in this role will review medical claims , prior and subsequent to billing, to ensure accuracy ... + Employee Assistance Programs. Essential Functions/Major Responsibilities Billing and Coding: + Review charges prior to initial claims submission to ensure… more
- Randstad US (Franklin, TN)
- …clinic in Franklin TN. Key Responsibilities: + Process and submit medical claims using eClinical Works. + Review and ensure the accuracy of billing ... medical billing clerk. + franklin , tennessee +...information and documentation. + Follow up on unpaid claims and resolve any discrepancies. + Communicate with insurance… more
- Martin's Point Health Care (Portland, ME)
- …policies, and internal guidelines for medical necessity reviews. + Manage the review of medical claims disputes, records, and authorizations for billing, ... medical necessity reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental… more
- ManpowerGroup (Columbia, SC)
- …the state of hire, OR, active compact multistate unrestricted RN license. **Responsibilities:** + Review medical claims and determine if services are covered ... one of our Fortune 500 clients. **Job Summary** The Medical Review and Utilization Management Specialist is...documenting decisions based on clinical guidelines, providing support for medical claims reviews, and ensuring that processes… more
- Amentum (Washington, DC)
- …+ Work with Claim Review Team Leads on weekly Eligibility-Only claim review assignments to SMO's for claims produced for approval. + Update SharePoint ... The CRST Project Supervisor - specific duties and responsibilities include: + Assist Claim Review Support Team Project Manager in all aspects of Claim Review … more
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will ... Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for...adjudication, clinical coding reviews for claims , settlement, claims auditing and/or utilization review required +… more
- UNC Health Care (Rocky Mount, NC)
- …to investigate medical circumstances and legal implications of incidents and claims . Review medical records, protocols, laws, policies and procedures ... risk financing, clinical loss prevention, risk identification and evaluation, claims management, and litigation management. Duties also include incident… more
Related Job Searches:
Claims,
Medical,
Medical Claims,
Medical Claims Review Coordinator,
Medical Claims Review Nurse,
Medical Review,
Medical Review Supervisor Claims,
Review