- Guardant Health (Palo Alto, CA)
- …Health oncology platform leverages capabilities to drive commercial adoption, improve patient clinical outcomes, and lower healthcare costs across all stages of the ... proven past performance that has met and exceeded expectations.Previous experience managing remote teams.7+ years of experience working with major cancer centers and… more
- Kepro (CA)
- …to being a vital partner for health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team in California. Job ... Summary As a Utilization Clinical Reviewer , you'll harness...a pivotal role in upholding industry benchmarks. This full-time Clinical Reviewer Remote position based… more
- Kepro (AR)
- … Reviewer to join our growing team. Summary Description The Dental Clinical Specialist is responsible for the Utilization Management and Utilization ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… more
- CVS Health (Frankfort, KY)
- …health care more personal, convenient and affordable. **Position Summary** This is a fully ** remote ** Utilization Review Clinical Consultant with a ... the standard schedule based on business needs **Preferred Qualifications** + Managed care/ utilization review experience + Ability to multitask, prioritize and… more
- Kepro (Minneapolis, MN)
- …the public sector. Acentra is looking for a Utilization Management - Mental Health Clinical Reviewer to join our growing team. This is a Remote position ... Job Summary: The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract… 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 ... utilization management team, and provides timely medical review of service requests that do not initially meet...clinical determinations cannot be made by the Initial Clinical Reviewer . + Discusses determinations with requesting… more
- AmeriHealth Caritas (Philadelphia, PA)
- ** Clinical Care Reviewer , Pediatric Shift Care, Registered Nurse** Location: Philadelphia, PA Primary Job Function: Medical Management ID**: 34518 **Job Brief** ... **Responsibilities:** Under the direction of the unit Supervisor, the Clinical Care Reviewer - Shift Care is responsible...Nurse working with medically fragile pediatric patients in a clinical setting. + 3+ years of Utilization … more
- Kepro (Lombard, IL)
- …leadership and clinical expertise to operations relating to the peer review process, utilization review activities, and other activities requiring ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...Acentra seeks an Internal Medicine or Family Practice Physician Reviewer (Illinois Remote , PRN) to join our… more
- The Cigna Group (Bloomfield, CT)
- …in Utilization Management. Handles moderately complex medical review , utilization review , credentialing/re-credentialing, quality assurance/improvement, ... clinical protocols; and authorizing coverage of services or referring requests for expert clinical review as appropriate. + Be available as an expert advisor… more
- Kepro (Lombard, IL)
- …leadership and clinical expertise to operations relating to the peer review process, utilization review activities, and other activities requiring ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...in the public sector. Acentra seeks an OBGYN Physician Reviewer (PRN, Remote within Illinois) to join… more
- Kepro (ND)
- …growing team. Job Summary: Our Nurse Clinical Reviewer will use clinical expertise for the review of medical records against appropriate criteria in ... + Knowledge of current National Committee for Quality Assurance (NCQA)/ Utilization Review Accreditation Commission (URAC) standards strongly preferred.… more
- Magellan Health Services (Honolulu, HI)
- …Hawaii. Under general supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and ... 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
- ManpowerGroup (Columbia, SC)
- …of medical claims review processes, medical necessity guidelines, and utilization review practices. + Proficiency in medical terminology, coding procedures, ... **Job Title: Medical Claims Reviewer ** **Pay Rate:23/Hr ( REMOTE opportunity after...services. + Ensure thorough documentation of each determination for utilization or claims review . + Review… more
- US Tech Solutions (Columbia, SC)
- …decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. + May provide any of ... equipment to be prepared. + The position is fully remote after that. + Please list out the top...sets/qualities: I would love to have someone with prior insurance/ utilization review experience, but I know that… more
- Centene Corporation (Tampa, FL)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... monitor care for behavioral health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and… more
- Scripps Health (San Diego, CA)
- …**Job:** **Pt Care Technical* **Organization:** **Scripps Health Corp* **Title:** *Quality LVN - Utilization Review - Remote within San Diego County* ... *Required Qualifications:* * Current California LVN license * Three years recent clinical experience in a variety of settings. * Managed Care experience is… more
- Spectrum Billing Solutions (Skokie, IL)
- …/in-office, or to work 100% fully remote . Your Responsibilities: + Review patient admission and clinical information to ensure medical necessity and ... streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing...will utilize his or her knowledge and skills to review clinical information and obtain initial and… more
- Elevance Health (Tampa, FL)
- …requirements:** + Requires a HS diploma or equivalent and a minimum of 2 years of clinical or utilization review experience and minimum of 1 year of managed ... **Licensed Utilization Review II** **Location** : KS, FL. and VA. This is a remote position The ideal candidate will live within 50 miles Elevance Health… more
- Centene Corporation (Jefferson City, MO)
- …zone with experience in mental health settings and utilization management / review . **Position Purpose:** Performs a clinical review and assesses care ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare ... by the applicable state required. Master's degree for behavioral health clinicians required. Behavioral health clinical knowledge and ability to review and/or… more
