- AmeriHealth Caritas (Charlotte, NC)
- …and providers to collect all information necessary to perform a thorough medical necessity review . It is within Clinical Care Reviewer UM discretion to pend ... **RN Clinical Care Reviewer , UM, Exchange Plan** Location: Charlotte, NC Primary...graduate from an accredited Registered Nurse program. Diploma or Associate 's Degree required. BSN preferred. Current and unrestricted RN… more
- Lee County Board of County Commissioners (Fort Myers, FL)
- Plan Reviewer Print (https://www.governmentjobs.com/careers/leecounty/jobs/newprint/4393761) Apply Plan Reviewer Salary $50,185.72 - $102,274.64 Annually ... + Questions Description JOIN OUR TEAM AS A PLAN REVIEWER ! *SALARY IS BASED ON POSSESSION OF CERTIFICATION AREA(S).... attends meetings, as required, and conducts preliminary plan review meetings with architects, engineers, developers and owners to… more
- Koniag Government Services (Germantown, MD)
- …Services, LLC,** a Koniag Government Services company **,** is seeking a Document Reviewer Level 5 (DRL5) with Top- Secret clearance to support **KPS** and our ... Services, a Koniag Government Services company, is seeking an experienced Document Reviewer Level 5 to join a dynamic team supporting critical projects involving… more
- ManpowerGroup (Warrendale, PA)
- Our client, a leading player in the manufacturing industry, is seeking a **Technical Reviewer ** to join their dynamic team. As a Technical Reviewer , you will ... zero workplace injuries and incidents across EESS. **Job Title:** Technical Reviewer **Location:** Warrendale, PA **Pay Range:** $85-$89/hr. (W2 Contract) **What's… more
- Commonwealth Care Alliance (Boston, MA)
- …under the provisions of CCA's benefits plan. The Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical and service authorization ... review for medical necessity and decision-making. The Utilization Management Reviewer has a key role in ensuring CCA meets CMS compliance standards in the area of… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... achieve that purpose. Job Summary The Utilization Management Clinical Quality Nurse Reviewer RN II, under the purview the Utilization Management (UM) Department… more
- City of New York (New York, NY)
- …Quality Control Case Reviewer , who will: - Conduct the preliminary monthly review of MICSA and HCSP cases selected from a sample of activated, recertified, ... Description YOU MUST BE PERMANENT IN THE PRINCIPAL ADMINISTRATIVE ASSOCIATE CIVIL SERVICE TITLE The Department of Social Services...Query (SOLQ) databases. - Ensure the accuracy of the review sample by conducting preliminary WMS inquiries and case… more
- City of New York (New York, NY)
- Job Description CANDIDATE MUST BE PERMANENT IN THE PRINCIPAL ADMINISTRATIVE ASSOCIATE CIVIL SERVICE TITLE. The Department of Social Services Accountability Office ... of Homeless Services (DHS). Within DSS-AO, the Process Evaluation Review Team (PERT) was created as an independent unit...reports. PERT is recruiting for (2) two Principal Administrative Associate III to function as a CA PERT Sr.… 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...contract requirements + Graduation from an accredited Technical, Diploma, Associate or Bachelor Degree Nursing Program + Minimum two… more
- Koniag Government Services (Germantown, MD)
- …Services, LLC,** a Koniag Government Services company, is seeking a Lead Document Reviewer Level 5 (DRL5) with Top- Secret clearance to support **KPS** and our ... area related to nuclear weapons + Two-year tour of duty as a Military Research Associate (MRA) or equivalent + Access to SCI clearance + Ability to read and… more
- Kepro (NC)
- …health solutions in the public sector. Acentra Health seeks a Regional Mentor QA Reviewer (RN - Hybrid) to join our growing team. Job Summary: The Regional Mentor ... other applicable State and/or Compact State clinical license and/or certifications. + Associate 's Degree or Bachelor's Degree Program + CCM preferred and/or required… more
- Magellan Health Services (Honolulu, HI)
- …quality of care. General Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work Experience - Required Clinical Work Experience - ... Preferred Education - Required Associate - Nursing, Bachelor's - Social Work, Master's - Social Work Education - Preferred License and Certifications - Required CEAP… more
- City of New York (New York, NY)
- Job Description YOU MUST BE PERMANENT IN THE PRINCIPAL ADMINISTRATIVE ASSOCIATE CIVIL SERVICE TITLE The DSS Accountability Office (DSS-AO) is responsible for ... as a Quality Control Case Reviewers, who will: - Review POS, HRA One Viewer of imaged/scanned documents, Welfare...work of more than moderate difficulty; or 2. An associate degree or 60 semester credits from an accredited… more
- US Tech Solutions (Columbia, SC)
- …TO HAVE skill sets/qualities: I would love to have someone with prior insurance/utilization review experience, but I know that is not very common. A good candidate ... meet requirements are sent on to an MD for review . Nurses will interact daily with providers, teammates, and...Practical Nursing or Licensed Vocational Nursing. + Preferred Education: Associate Degree- Nursing OR Graduate of an Accredited School… more
- City of New York (New York, NY)
- Job Description APPLICANTS MUST BE PERMANENT IN THE PRINCIPLE ADMINISTRATIVE ASSOCIATE CIVIL SERVICE TITLE. The Office of Quality Assurance & Fiscal Integrity ... federal, state and city regulatory requirements. The Process Evaluation Review Team (PERT) is tasked with aggressively monitoring program...work of more than moderate difficulty; or 2. An associate degree or 60 semester credits from an accredited… more
- City of New York (New York, NY)
- Job Description APPLICANTS MUST BE PERMANENT IN THE PRINCIPAL ADMINISTRATIVE ASSOCIATE CIVIL SERVICE TITLE. The Process Evaluation Review Team (PERT) is tasked ... and recertification cases. Measure timeliness and adequacy of notices. Review Paperless Office System (POS) entries. Review ...work of more than moderate difficulty; or 2. An associate degree or 60 semester credits from an accredited… more
- SSM Health (MO)
- …services rendered. The CDI Specialist assesses clinical documentation through extensive review of the medical record, interaction with physicians, nursing staff, ... the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate diagnosis review group (DRG) assignment, risk of mortality (ROM), and severity of… more
- City of New York (New York, NY)
- Job Description You must be permanent in the Clerical Associate Civil Service title. The New York City Human Resources Administration (HRA) provides temporary help ... the participants. The Career Services is recruiting for one (1) Clerical Associate III to function as Documentation Reviewers who will: Facilitate participant intake… more
- Bristol Myers Squibb (Indianapolis, IN)
- …a Bristol Myers Squibb company, is seeking applicants for a Quality Control Data Reviewer . We are seeking a detail-oriented Quality Control Data Reviewer to play ... position located at Rayzebio's Indianapolis, IN site **Key Responsibilities:** + Review Quality Control data for accuracy, completeness and compliance with… more
- Grifols Shared Services North America, Inc (Clayton, NC)
- …in more than 110 countries and regions. Shift: Day - Hybrid Model **Quality Associate II/III** The Quality Associate II/III will be assigned duties and ... pooling to packaged final container is preferred.** **Primary Responsibilities for Quality Associate II** * Coordinates SAP Quality related creations and changes in… more