- Magellan Health Services (Boise, ID)
- …minimal supervision. Project management skills and demonstrated experience. General Job Information Title Quality Clinical Reviewer ( Remote - Must live ... and external reporting. Interacts with multiple stakeholders internally and externally. Provides clinical reviews of Quality of Care (QOC) and Critical/Adverse… more
- Chenega Corporation (NM)
- …Solutions, LLC,** a **Chenega Professional Services** ' company, is looking for a fully remote ** Clinical Quality Reviewer ** to ensure compliance with ... the contract, and program requirements for Clinical Quality Management (CQM) within TRICARE West...and URAC standards for consistency. Supports activities of peer review and quality and safety committees. Our… more
- University of Miami (Hialeah, FL)
- … this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Concurrent Quality Reviewer of our hospital reviews ... CDIs, Coders, Quality , and other relevant multidisciplinary teams. The concurrent inpatient quality reviewer will assign a working DRG, as well as capture… more
- Kepro (Portland, ME)
- …and consistency of the Psychiatric Inpatient Concurrent Review process. This full-time Clinical Reviewer Remote position based in the state of Maine. ... lAcentra seeks a Clinical Reviewer to join our growing...a focus on meeting production targets and maintaining top-tier quality assurance standards, this role serves as the linchpin… more
- Kepro (AR)
- …Preferred Qualifications/Experience: + Utilization Review /Utilization Management experience. + Clinical quality review experience with medical records. ... health solutions in the public sector. Acentra is looking for a Clinical Reviewer - Behavioral Health - PRN ( Remote within Arkansas) ** The selected… more
- Prime Therapeutics (Columbus, OH)
- …fuels our passion and drives every decision we make. **Job Posting Title** Physician Clinical Reviewer - GI- REMOTE **Job Description Summary** Key member of ... clinical determinations cannot be made by the Initial Clinical Reviewer . + Discusses determinations with requesting...as needed to discuss cases and problems. + Utilizes medical/ clinical review guidelines and parameters to assure… more
- Magellan Health Services (Baton Rouge, LA)
- …management according to medical necessity criteria. General Job Information Title Clinical Reviewer III (Baton Rouge, LA or Remote in LA) Grade 26 Work ... other clinical staff. + Provides training, interpretation and support for QI Clinical Reviewer staff. + Audits and validates internal audit results and/or… more
- The Cigna Group (Bloomfield, CT)
- …to Care Managers, Clinical Managers, Providers and other Peer Reviewers in clinical quality improvement process. + Acts as behavioral health consultant in ... Performs peer review and case management activities. Delivers clinical expertise to the organization through peer review , decision making, training,… more
- HCA Healthcare (Corpus Christi, TX)
- …step in your career path, we encourage you to apply for our Registered Nurse Clinical Reviewer opening. We review all applications. Qualified candidates will ... you have the career opportunities as a(an) Registered Nurse Clinical Reviewer you want in your current...including Core Measure chart abstraction, Stroke & STEMI chart review and coordination; performs concurrent chart reviews & is… more
- Kepro (AL)
- …Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver ... for health solutions in the public sector. Acentra is seeking a Physical Therapist Reviewer PRN to join our growing team. **MUST RESIDE IN THE STATE OF ALABAMA**… more
- HCA Healthcare (Corpus Christi, TX)
- …step in your career path, we encourage you to apply for our Registered Nurse Clinical Reviewer PRN opening. We review all applications. Qualified candidates ... you have the career opportunities as a(an) Registered Nurse Clinical Reviewer PRN you want in your...Medical Center Bay Area!** **Job Summary and Qualifications** **The Quality Review Nurse position encompasses multiple responsibilities… more
- Magellan Health Services (Honolulu, HI)
- …facilities, develops discharge plans and oversee their implementation. + Performs quality clinical reviews while educating and making appropriate interventions ... Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work...Remote Hawaii Grade 24 Work Experience - Required Clinical Work Experience - Preferred Education - Required Associate… more
- Zelis (NJ)
- Position Overview: At Zelis, the Itemized Bill Review Facility Reviewer is responsible for analyzing facility inpatient and outpatient claims for Health Plans ... be responsible for developing new concepts, assisting with the quality assurance program, and being a resource for the...overall claims progression + Complete claims processing after the Clinical Bill Review and Audit analysis is… 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 ... healthcare? Bring your true colors to blue. 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
- SSM Health (MO)
- …(CDI) specialist is responsible for facilitating the improvement in the overall quality and completeness of provider-based clinical documentation in the medical ... **It's more than a career, it's a calling** MO- REMOTE **Worker Type:** Regular **Job Highlights:** At SSM...the level of services rendered. The CDI Specialist assesses clinical documentation through extensive review of the… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Your Day to Day : + Conduct pre-certification and concurrent and retrospective clinical review of in-state and out-of-state inpatient cases at acute residential ... Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating...by providers that include treatment goals, interventions, and expected clinical outcomes and that support quality and… more
- Elevance Health (Chicago, IL)
- **Be Part of an Extraordinary Team** **Title** : Nurse Reviewer **Location:** FULLY REMOTE ; candidates must reside within 50 miles or 1-hour commute each way of ... CST **Build the Possibilities. Make an Extraordinary Impact.** The **Nurse Reviewer ** is responsible for conducting preauthorization, out of network and… more
- Medical Mutual of Ohio (OH)
- …provide peace of mind to more than 1.2 million members through our high- quality health, life, disability, dental, vision and indemnity plans. We offer fully insured ... and individual plans. Under limited supervision, the Medicare Nurse Reviewer applies medical necessity guidelines in making authorization determinations for… more
- US Tech Solutions (May, OK)
- …Participates in the collection and review of medical records to abstract clinical information for HEDIS quality reporting. Training will be provided prior to ... Job Title: HEDIS Reviewer II Location: Remote Duration: 7...Duration: 7 months Job Description: This position interprets relevant clinical criteria through review of medical records,… more
- Trinity Health (Livonia, MI)
- …Full time **Shift:** **Description:** Trinity Health at Home is seeking an experienced RN remote Clinical Quality Review Specialist with ICD10 HCS-D ... **Trinity Health at Home is seeking an experienced RN Clinical Quality Review Specialist for a remote position** **ICD10 HCS-D certification which is… more