- US Tech Solutions (Canton, MA)
- …extension)** Notes: Fully remote , MA license required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that ... independently as well as collaboratively within a team environment. The Clinical Reviewer will be expected to demonstrate sound clinical and health plan… more
- PeaceHealth (Vancouver, WA)
- …knowledge of current Medicare part A and how it impacts DRG assignment to the review of clinical documentation. + Performs other duties as assigned. What You ... **Description** PeaceHealth is seeking a RN Denial Reviewer for a Full Time, 1.00 FTE, Day...denials and appeals management. Performs in depth reviews of clinical DRG downgrade denials to draft appeal letters for… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …benefits, as well as regulatory and NCQA requirements. + Refer to RN or PT Clinical Utilization reviewer for more complex cases as appropriate or when question ... data to support reason for PRU referral. + Collaborate within a team of professionals, including clinical ...with external facility or providers as needed to gather clinical information to support the medical necessity review… more
- AmeriHealth Caritas (Charleston, SC)
- …information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer 's discretion to retain requests for additional ... the direction of the Supervisor, the Behavioral Health Utilization Management Reviewer is responsible for completing medical necessity reviews. ;Using clinical… more
- SSM Health (MO)
- **It's more than a career, it's a calling** MO- REMOTE **Worker Type:** Regular **Job Highlights:** **Preferred Qualifications:** + CCDS certification + Proficiency ... **Required Qualifications:** + 12 months of experience as a Clinical Documentation Specialist + Graduate of accredited school of...in an acute care setting or relevant experience **Eligible Remote States:** Candidates are required to reside on one… more
- Elevance Health (Rancho Cordova, CA)
- …or requires physician review or override. + Clearly and concisely documenting clinical review and other case interactions in online database in adherence to ... **JR144792 Genetic Counselor Reviewer ** The genetic counselor reviewer (GCR)...use of member benefits. **Location:** This position will work remote and must live within 50 miles… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for members who ... Mobile, and Resident personas. This position can be fully remote , with a 1-2x/month meeting in our Hingham, MA...Hours of work: 8:30a - 4:30p EDT. The TeamThe Clinical Utilization Reviewer is part of a… more
- The Joint Commission (Oakbrook Terrace, IL)
- …Field Representatives, with minimal direction or supervision, survey and/or review health care organizations throughout the United States. Field Representatives ... **Responsibilities** Position Accountabilities: + Ability to analyze and synthesize survey/ review findings to provide conclusions, recommendations and educational opportunities.… more
- ManpowerGroup (Columbia, SC)
- **Utilization Management Nurse / Social Worker (Contract Position)** **Location:** Remote (Must Train Onsite for 1-2 Weeks) - Must Reside Within 3 Hours of ... communicate with members and healthcare providers. **Key Responsibilities** ✔ **Medical Review & Utilization Management (80%)** + Perform medical reviews using… more
- Zelis (TX)
- …records utilizing ICD-10 Official Coding Guidelines, AHA Coding Clinic evidence based clinical criteria and client specific coverage policies. What you will do: + ... billed, based on industry standard coding guidelines and the clinical evidence supplied by the provider in the form...on DRG validation to team members and other departments within the organization + Prepare and conduct training for… more
- Actalent (Dallas, TX)
- …and collaboration with key facility personnel within the healthcare setting. + Use clinical expertise to review clinical information and clinical ... status to ensure optimal outcomes. + Act as a clinical resource for unlicensed Post-Acute Care Coordinators, providing ...telephonic touch points with each facility point person to review each member within that facility and… more
- Medtronic (Fridley, MN)
- …design and associated statistical analysis development as well as assisting with other clinical evidence data sets within the Neuromodulation and Pelvic Health ... the Life** In this exciting role as a Senior Clinical Data and Biostatistical Sciences Manager, you will be...medical technology and solutions. _This is a local or remote based role so the candidate can live anywhere… more
- Cedars-Sinai (Beverly Hills, CA)
- …surpluses. Negotiates with sponsors the final payment due for account closeout. May conduct review and/or audits of clinical trial budgets. Serves as a resource ... and clinical trial budget. + Performs Medicare coverage analysis for clinical trials and collaborates with Institutional Review Board (IRB) to finalize… more
- Walgreens (Deerfield, IL)
- **Job Description:** **Job Summary:** Walgreens RWE (Real World Evidence) Clinical Trials is seeking a remote Account Manager, RWE Clinical Trials with ... disability/veterans". \#LI-TO1 **Job ID:** 1506161BR **Title:** Account Manager, RWE Clinical Trials - Remote **Company Indicator:** Walgreens **Employment… more
- Cedars-Sinai (Beverly Hills, CA)
- …surpluses. Negotiates with sponsors the final payment due for account closeout. May conduct review and/or audits of clinical trial budgets. Serves as a resource ... and clinical trial budget. + Performs Medicare coverage analysis for clinical trials and collaborates with Institutional Review Board (IRB) to finalize… more
- UTMB Health (Galveston, TX)
- Clinical Documentation Specialist ( Remote -Texas Resident) - Clinical Data **Galveston, Texas, United States** **New** Medical Administrative UTMB Health ... school graduate) with a minimum of 3 years inpatient clinical experience, advanced clinical expertise and an...this MQ) **And** Must acquire CCDS or CDIP certification within 3 years of hire **Preferred Qualifications:** + **For… more
- Amgen (Washington, DC)
- …worldwide. It's time for a career you can be proud of. Join us. ** Clinical Research Medical Director, Endocrinology/Obesity - US Remote ** **What you will do** ... The Cardiovascular/Metabolic Therapeutic Area is seeking a Clinical Research Medical Director to play a leadership role...play a leadership role on one or more studies within the maridebart cafraglutide (AMG 133) global development program… more
- Actalent (Maple Grove, MN)
- x2 Openings - Remote CTM supporting Sr. CTM on exciting Clinical Trials! Interviews will be scheduled quickly! Please inquire within if interested in ... discussing further and experience aligned. Overview: We are seeking a dedicated Clinical Trial Manager to support our Lead CTM in managing Medical Device studies… more
- Walgreens (Deerfield, IL)
- …for clinical trial design, protocol development, and execution including review of new business proposals, clinical trial data, feasibility analysis, ... issues + Provides medical review of eCRFs and data analysis plan for clinical accuracy + Reviews safety fields at case freeze for reconciliation (if needed) +… more
- Medtronic (Chicago, IL)
- …to learn more about our Neuromodulation Product Portfolio. This position can be remote from anywhere within the United States or work a hybrid ... a region/country may also have responsibilities that include representing Medtronic clinical research within the country/region and collecting feedback from… more