- Novo Nordisk Inc. (Minneapolis, MN)
- …and community thought-leaders in an assigned territory. The Rare Renal Clinical Account Manager will be principally responsible for driving disease awareness, ... establishing NNI as a leader in the rare renal marketplace. The Rare Renal Clinical Account Manager (RRCAM) will be responsible for achieving sales targets and other… more
- Novo Nordisk Inc. (Topeka, KS)
- …treatment of diabetes, obesity, and the reduction of adverse cardiovascular events. As part of the team, you will have frontline exposure to our portfolio vision, ... same. In exchange, we offer the chance to be part of a truly global workplace, where passion and...and other stakeholders in a given geography. Utilizing approved clinical resources to support provider efforts to deliver appropriate… more
- Novo Nordisk Inc. (Torrance, CA)
- …assess, create and maintain advocacy of customers aligned to company, brand and clinical goals. The OCS develops local strategies and executes local tactical plans ... partners. The OCS also assists their customers with their local clinical and educational initiatives by coordinating company resources (eg, counterparts, materials,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …for the following personas: eWorker, mobile and resident. The Team The Clinical Utilization Reviewer is part of a highly dedicated and motivated team ... Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible...Day : + Conduct pre-certification and concurrent and retrospective clinical review of in-state and out-of-state inpatient… more
- Guthrie (Binghamton, NY)
- …for prior authorization/certification for reimbursement of patient care services. The Utilization Reviewer : * Secures authorization as appropriate * Documents ... LPN - Utilization Management (Days) Full Time Position Summary: The Utilization Management (UM) Reviewer , in collaboration with other internal and external… 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 the ... utilization management team, and provides timely medical ...clinical determinations cannot be made by the Initial Clinical Reviewer . + Discusses determinations with requesting… more
- Evolent Health (Columbus, OH)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Physician Clinical Reviewer you will be a key member of the utilization ... when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the… more
- Evolent Health (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 ... provides clinical rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD… more
- Trinity Health (Livonia, MI)
- …Type:** Part time **Shift:** Rotating Shift **Description:** **JOB SUMMARY** The Clinical Nurse Reviewer 's chief responsibility is to collect and submit ... database of all eligible cases for the hospital. The Clinical Nurse Reviewer also works closely with...software (Microsoft Word, Excel, PowerPoint) and web-based applications. + Clinical chart review and abstraction experience required… more
- Hartford HealthCare (Hartford, CT)
- …care and more than 30 different specialties. *_ Job Description_* The Surgical Clinical Reviewer 's (SCR) chief responsibility is to collect and submit reliable ... **Administrative* **Organization:** **Hartford HealthCare Medical Group Specialists* **Title:** *Surgical Clinical Reviewer - General Surgery* **Location:** *Connecticut-Hartford-85… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The Clinical Pharmacist Reviewer reviews formulary exception, prior authorization and quantity ... phone and fax for the Retail Pharmacy, Medicare Advantage Part D, Home Infusion Therapy, and Medical Utilization...Utilization Management for pharmaceuticals programs. + Partner with clinical and non- clinical teams for staff training,… more
- Elevance Health (Sacramento, CA)
- …or requires physician review or override. + Clearly and concisely documenting clinical review and other case interactions in online database in adherence to ... **JR132259 Genetic Counselor Reviewer ** The genetic counselor reviewer (GCR)...for authorization requests and determining their appropriateness per designated clinical guidelines, clinical policies, and client rules.… more
- Banner Health (AZ)
- …on your experience as a Registered Nurse and your knowledge of Case Managment and Utilization Management to review clinical records to ensure patients are in ... or other staff of non-company locations on concurrent and retrospective utilization review . Accurately and thoroughly completes documentation required for… more
- BayCare Health System (Clearwater, FL)
- …Opportunity Employer Veterans/Disabled **Position** Utilization Review Specialist Senior **Location** Clearwater | Clinical | Part Time **Req ID** null ... and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and compassionate… more
- CaroMont Health (Gastonia, NC)
- …RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal ... practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case Management preferred. Minimum… more
- Kelsey-Seybold Clinic (Houston, TX)
- **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to ... authorization prior to services being rendered for members. The Utilization Review Specialist (LVN) serves as a...plan, ACO, IPA, or provider group or 3 years clinical nursing experience Preferred: N/A **License(s)** Required: TX LVN… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services...and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General… more
- Prime Healthcare (Reno, NV)
- …Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities Utilization Review Manager ... offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference....is responsible for the oversight of third party payer utilization review (UR) and the denial management… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Sutter Health (Berkeley, CA)
- …and others to ensure appropriate utilization and quality care through utilization review , tracking and evaluation and objectively compare criteria with ... nursing staff and other departments regarding documentation required for utilization review activities and processes. Collaborate with medical, nursing… more
