- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …adjudicate these requests. At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical ... transform healthcare? Bring your true colors to blue. The Physician Reviewer is responsible for evaluating clinical..., in partnership with case managers + Participate in Physician Psychologist Review Units' appeal process of… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …providers, as appropriate. At the request of the Senior Medical Director of the Physician Review Unit (PRU), the reviewer also provides clinical leadership ... Ready to help us transform healthcare? Bring your true colors to blue. The physician reviewer is responsible for evaluating pre & post-service clinical service… more
- Evolent (Columbus, OH)
- …Evolent 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 ... **What You Will Be Doing:** + Serve as the Physician match reviewer in Imaging cases, that...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Apex Health Solutions (Houston, TX)
- …as a contact and resource person to Health Solutions' members for the utilization review (UR) of healthcare services. The UM Reviewer will be responsible for ... well as carrying out day today pre-authorization functions. The Utilization Review Nurse will also be responsible for issuing pre-authorization approvals/denials,… more
- HCA Healthcare (Nashville, TN)
- …invested over 156,000 hours volunteering in our communities. As a Coding Quality Audit Reviewer with Work from Home you can be a part of an organization that ... We are looking for an enthusiastic Coding Quality Audit Reviewer to help us reach our goals. Unlock your...result in appropriate reimbursement and data integrity. You will review outcomes are communicated to the HSC team to… more
- Elevance Health (Grand Prairie, TX)
- …determining whether clinical information presented meets medical necessity criteria or requires physician review or override. + Clearly and concisely documenting ... **JR139503 Genetic Counselor Reviewer ** The genetic counselor reviewer (GCR) is...clinical review and other case interactions in online database in adherence… more
- University of Miami (Hialeah, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... Concurrent Quality Reviewer of our hospital reviews documentation in the electronic...Documentation Specialists for concurrent queries to the providers, ensuring physician responses to queries are reflected in the code… more
- Elevance Health (Chicago, IL)
- …and business leaders passionate about transforming American healthcare delivery. **Nurse Reviewer I** **Location:** **Illinois. This is a remote position working ... our Elevance Health PulsePoint location in** **Chicago, Illinois** **.** The **Nurse Reviewer I** is responsible for conducting preauthorization, out of network and… more
- Elevance Health (San Juan, PR)
- …providing information technology and business operations services for health plans._ **Nurse Reviewer I** **Location:** This position will work a hybrid model (1-2 ... US States time zones that the unit will be supporting. The **Nurse Reviewer I** is responsible for conducting preauthorization, out of network and appropriateness of… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …healthcare? Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care for members who may have complex ... the following personas: eWorker, mobile and resident. The Team The Clinical Utilization Reviewer is part of a highly dedicated and motivated team of professionals,… more
- Hartford HealthCare (Shelton, CT)
- …Island. We consist of a team of professionals ranging from Medical Assistants to Physician Assistants and everything in between. Our physician led medical group ... specialties. *_ Job Description_* The Metabolic and Bariatric Surgical Clinical Reviewer 's (MBSCR) chief responsibility is to collect and submit reliable data… more
- Hartford HealthCare (Hartford, CT)
- …Island. We consist of a team of professionals ranging from Medical Assistants to Physician Assistants and everything in between. Our physician led medical group ... and more than 30 different specialties. *_ Job Description_* The Surgical Clinical Reviewer 's (SCR) chief responsibility is to collect and submit reliable data to… more
- Kepro (Harrisburg, PA)
- …vital partner for health solutions in the public sector. Acentra seeks a Clinical Reviewer to join our growing team. Job Summary: Utilizes clinical expertise for the ... review of medical records against appropriate criteria in conjunction...need for services + Initiates a referral to the physician consultant and processes physician consultant decisions… more
- The Joint Commission (Oakbrook Terrace, IL)
- **Overview** The Disease Specific Care Reviewer -Ortho is responsible to review the following certification programs-Total Hip Replacement, Total Knee ... that care. **Qualifications** Advanced Degree in Nursing or Licensure as a Physician required. Board Certification in Orthopedics required. Or a Doctorate prepared… more
- Magellan Health Services (Honolulu, HI)
- …and company policies and procedures, and criteria. + Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding ... quality of care. General Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work Experience - Required Clinical Work Experience -… more
- SSM Health (MO)
- …services rendered. The CDI Specialist assesses clinical documentation through extensive review of the medical record, interaction with physicians, nursing staff, ... information to identify areas within the chart for potential gaps in physician documentation. Queries physicians on a concurrent basis. Works with physicians to… more
- SSM Health (MO)
- …Performs concurrent analytical reviews of clinical and coding data to improving physician documentation for all conditions and treatments from point of entry to ... the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate diagnosis review group (DRG) assignment, risk of mortality (ROM), and severity of… more
- Merck (North Wales, PA)
- …support collaboration to further differentiate our portfolio. The Medical Consult and Review Physician provides clinical expertise and advice to internal ... Teams. In Promotional Review Team, the Medical Consult and Review Physician is responsible for ensuring the clinical relevance and medical accuracy of… more
- WMCHealth (Valhalla, NY)
- …and/or Case management Physician Advisor or having 3-5 years as a Physician Reviewer /Advisor with a third party leveling and/or appeals agency preferred. ... Physician Advisor Company: WMC Advanced Physician ...when clinical determinations cannot be made by initial clinical review . + Discusses determinations with requesting physicians or ordering… more
- Vighter Medical Group (Laredo, TX)
- Regional Physician Supervisor (MD), Laredo,TX Job Details Job Location Laredo BPS, Laredo, TX - Laredo, TX Position Type 1099 Education Level Doctorate (DO or MD) ... Up to 25% Job Shift Any Job Category Health Care Description Title:Regional Physician Supervisor Location:El Paso, TX; Laredo; Rio Grande Valley, TX; West Palm… more
Related Job Searches:
Physician,
Physician Clinical Reviewer,
Physician Reviewer BH Pru,
Physician Reviewer Behavioral Health,
Psychiatrist Physician Reviewer PRN,
Reviewer