- Christus Health (Irving, TX)
- …efficiency Collaborate with Health Informatics colleagues across the Ministries in the review and update of order sets Understand and articulate the "connections" ... Management and other departments such as Pharmacy, Information Management, Quality, Case Management, Revenue Cycle and Finance Responsible for other duties as… more
- City of New York (New York, NY)
- …Review Team within the Office of Quality Improvement (OQI), the Case Reviewer will be responsible for a multisystem review of Connections, the Legal ... System (CAS) and other databases to complete a comprehensive case review . The Case Reviewer will also perform other duties that facilitate improvements… more
- City of New York (New York, NY)
- …within the Division of Child Protection (DCP) across each borough and zone. The Case Reviewer utilizes a standardized instrument to assess case practice. ... The duties and responsibilities of the Case Reviewer will include, but will not be limited to:...unaddressed safety and risk related concerns identified during the case review . - Complete a quality control… more
- City of New York (New York, NY)
- …The Office of Constituent Services (OCS) is seeking (1) Eligibility Specialist II to function as Case Reviewer . The Case Reviewer will: - Respond to ... (NAMI-Net Available Monthly Income) if institutionalized. - Interview and/or review documentation submitted by applicants/recipients (A/R) or authorized representatives,… more
- City of New York (New York, NY)
- …for (1) one Principal Administrative Associate II to function as a Quality Control Case Reviewer , who will: - Conduct the preliminary monthly review ... the review sample by conducting preliminary WMS inquiries and case review ; utilize reports to verify that sample is auditable; identifies inconsistencies,… more
- City of New York (New York, NY)
- …the final report. CA PERT Sr. Reviewer prepares lawsuit packets for each case in the review for electronic transmission to NYC Corporation Counsel. - Conduct ... during customer interaction, and determine whether appropriate action was taken. - Review case file information, POS entries and WMS data to report on the… more
- City of New York (New York, NY)
- …of Constituent Services (OCS) is seeking three (3) Eligibility Specialist II's to function as Case Reviewers. The Case Reviewer will: - Respond to inbound ... (NAMI-Net Available Monthly Income) if institutionalized. - Interview and/or review documentation submitted by applicants/recipients (A/R) or authorized representatives,… more
- Trinity Health (Athens, GA)
- …**Position Summary:** To assist with the coordination of the ongoing processes for identifying opportunities to improve the quality of care and services at St. Mary's ... Health Care System. To assist with the coordination of Medical Staff Performance Improvement activities. To compile data and assist with maintaining Physician profiles. **II. Position Requirements** : **A: Licensure/Certification/Registration** : Current… more
- City of New York (New York, NY)
- …legal and federal, state and city regulatory requirements. The Process Evaluation Review Team (PERT) is tasked with aggressively monitoring program compliance with ... Assurance & Fiscal Integrity (OQA&FI) / The Process Evaluation Review Team (PERT) is recruiting for (2) one Principal...one Principal Administrative Associates III, to function as Senior Case Reviewers who will: - Conduct legally mandated … more
- City of New York (New York, NY)
- …for one (1) Principal Administrative Associate II to function as a Quality Control Case Reviewers, who will: - Review POS, HRA One Viewer of imaged/scanned ... to ensure that data collected is complete, accurate and appropriate to the case under review . - Prepare manual budgets to replicate the actual amounts issued to… more
- City of New York (New York, NY)
- …THE PRINCIPAL ADMINISTRATIVE ASSOCIATE CIVIL SERVICE TITLE. The Process Evaluation Review Team (PERT) is tasked with aggressively monitoring program compliance with ... for (2) two Principal Administrative Associates IIIs, who will function as Senior Case Reviewers: - Conduct legally mandated case reviews to comply with… more
- CVS Health (Phoenix, AZ)
- …caseworkers assigned to you for support. You will perform an end-to-end quality review of written grievances resolution letters and summaries that are drafted by the ... quality objectives are met. Based on the outcome of case reviews, you will identify quality or productivity issues...needed. This may include working grievance cases, final quality review , and supporting grievance triage and assignment. To be… more
- Kepro (AR)
- …) to join our growing team. Job Summary: The Dental Physician Reviewer -Oral Surgeon will oversee utilization review /management activities to include peer ... review , utilization review , fair hearings and appeals, and other clinical consultations...related to the applicable contract. The Oral Surgeon Physician Reviewer will support the dental UM contract for Arkansas… more
- The Hartford (Alpharetta, GA)
- Medical Reviewer - CT08BE We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here ... future. The Clinical team is seeking an Initial Clinical Reviewer . This is a 100% in office position (Hartford,...(Hartford, CT or Alpharetta, GA) that will perform Utilization Review for Work ers' Compensation Claims. An Initial Clinical… more
- Elevance Health (Sacramento, CA)
- …of patient and provider specific information. + Contributing to team projects aimed to ensure case review accuracy and efficiency, such as updating case ... **JR132259 Genetic Counselor Reviewer ** The genetic counselor reviewer (GCR)...review processes, reporting issues, and creating internal case review resources. **Minimum requirements:** + Requires… more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, October 7, 2024 Centers Plan for Healthy Living's goal is to ... need for healthy living. JOB SUMMARY: The Grievance & Appeal Clinical Reviewer performs complex medical necessity reviewed on Initial Adverse Determinations or… 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
- Kepro (AR)
- …for health solutions in the public sector. Acentra is looking for a Clinical Reviewer - Behavioral Health - PRN (Remote within Arkansas) ** The selected candidate ... with relevant Arkansas Medicaid regulations and referring services to the Physician Reviewer for medical necessity determination if warranted. + Acts as a liaison… more
- Trinity Health (Livonia, MI)
- …Part time **Shift:** Rotating Shift **Description:** **JOB SUMMARY** The Clinical Nurse Reviewer 's chief responsibility is to collect and submit reliable data on ... database of all eligible cases for the hospital. The Clinical Nurse Reviewer also works closely with the physician champion and appropriate hospital leadership… more
- Guthrie (Binghamton, NY)
- …Management (Days) Full Time Position Summary: The Utilization Management (UM) Reviewer , in collaboration with other internal and external offices, payors, and ... authorization/certification for reimbursement of patient care services. The Utilization Reviewer : * Secures authorization as appropriate * Documents payer… more
