- U of C NORC (Bethesda, MD)
- …and skilled researchers live throughout the US and actively supports remote work arrangements.DEPARTMENT: Health Care Evaluation Research NORC's expertise and ... of pharmaceutical and biosimilars therapy for chronic and high-cost conditions, including clinical outcomes, trends, and shifts in clinical standardsMonitor and… more
- Pacer Staffing (Atlanta, GA)
- Job Title: Clinical Coder Location: 100% Remote Duration: 6+ months (Contract To Hir e) Shift: 5x8 Hour Shifts, Monday-Friday Job Summary Conducts retrospective ... provider claim review requests, develops determination letters, and supports both non- clinical and clinical staff on coding and retrospective medical claims … more
- US Tech Solutions, Inc. (Columbia, SC)
- …benefits or services, and appeals. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and ... equipment to be prepared. . The position is fully remote after that. . Please list out the top...I would love to have someone with prior insurance/utilization review experience, but I know that is not very… more
- Pacer Staffing (Atlanta, GA)
- Position Title: Care Coordinator Supervisor Location: Remote Schedule: Standard Duration: 3+ Months, "Contract to Hire" Summary: Supervises daily operations of care ... updates, policy revisions, performance outcomes, and significant events. Advises non- clinical staff regarding support tasks. Supervisors are responsible for… more
- Pacer Staffing (Atlanta, GA)
- …cover any work shift . Ability to work overtime, if needed . Onsite: Works within a standard office environment . Remote : Private and secure workspace and ... Required . Current, unrestricted RN licensure to independently work within scope of practice within state of...in a NCL state . Minimum of three years clinical experience . Experience in case management, care coordination… more
- Spectraforce Technologies Inc (Atlanta, GA)
- … remote setting Education/Experience RN or LPN/LVN license HEDIS Medical Record Review experience preferably within the last 5 years Computer experience (ie, ... Job Title: HEDIS Nurse Abstractor (100% REMOTE ) Duration: 3-4 Months Job Description The Healthcare...Nurse Abstractor works under the direction of the HEDIS Clinical Measurement and Improvement Lead and other Company personnel… more
- CornerStone Staffing (Dallas, TX)
- …necessaryWork on problems of moderate scope where analysis of data requires a review of a variety of factorsExercise judgment within defined standard operating ... those products, identifying alternative funding when insurers do not pay, and providing clinical services. Are you ready to start your next opportunity? JOB TITLE:… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …patient needs; Works collaborate with the Physicians, patient/family, nursing, utilization review and other members of the healthcare team to assure patient ... and effectively aligns with patient needs using resources to meet quality, clinical and cost effective outcomes. Coordinates a team approach designed to facilitate… more
- OU Health (Oklahoma City, OK)
- …facilities, outpatient physician practices, diagnostic/urgent care centers and remote statewide outreach clinics.Prepares patients for procedures and correlates ... clinical history with procedures ordered by physicians to be...in accordance with established scope of practice guidelines.Conducts post-procedure review with or without preceptor to confirm that all… more
- Cambia Health Solutions, Inc (Portland, OR)
- Behavioral Health Utilization Management Clinician Work from home within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a ... our Clinicians provide utilization management (such as prospective concurrent and retrospective review ) to best meet the member's specific healthcare needs and to… more
- Kepro (CA)
- …regulatory bodies, you'll play a pivotal role in upholding industry benchmarks. This full-time Clinical Reviewer Remote position based in the state of ... solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team...the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process in alignment with the California Mental Health… more
- Marshfield Clinic (Minocqua, WI)
- …together to support the most exciting missions in the world!** **Job Title:** Clinical Integration Technology Analyst ( Remote /Hybrid within MCHS Service ... States of America) **Job Description:** **This position will work remote with onsite support as needed. Individual will need...support as needed. Individual will need to be located within the state of WI.** **Job Description** **JOB SUMMARY**… 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 ... clinical determinations cannot be made by the Initial Clinical Reviewer . + Discusses determinations with requesting...as needed to discuss cases and problems. + Utilizes medical/ clinical review guidelines and parameters to assure… more
- AmeriHealth Caritas (Philadelphia, PA)
- ** Clinical Care Reviewer , Pediatric Shift Care, Registered Nurse** Location: Philadelphia, PA Primary Job Function: Medical Management ID**: 34518 Your career ... www.amerihealthcaritas.com. **Responsibilities:** Under the direction of the unit Supervisor, the Clinical Care Reviewer - Shift Care is responsible for managing… more
- Kepro (AR)
- …Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver ... in the public sector. Acentra seeks a Dental Hygienist Reviewer to join our growing team. Summary Description The...to join our growing team. Summary Description The Dental Clinical Specialist is responsible for the Utilization Management and… more
- Kepro (Lombard, IL)
- …vital partner for health solutions in the public sector. Acentra seeks an OBGYN Physician Reviewer (PRN, Remote within Illinois) to join our growing team. ... Job Summary: The OB/GYN Physician Reviewer will provide principal leadership and clinical ...stay criteria for IL Medicaid Fee-For-Service beneficiaries. *Position is remote but candidates must reside within the… more
- WTW (Boston, MA)
- …for providing support to United States based Health and Benefits Consultants and Clients. Within this role, as a member of North America client team, you will ... to timeline proactively to Project Manager + Complete initial review of carrier responses for parity projects + Draft...and client specific responses + Collaborate with MHPAEA senior reviewer and Project Manager to conduct follow up calls/emails… more
- Kepro (Lombard, IL)
- …continued stay criteria for IL Medicaid Fee-For-Service beneficiaries. *Position is PRN and remote within the state of Illinois. Job Responsibilities: + Conduct ... in the public sector. Acentra seeks a Psychiatrist Physician Reviewer (Illinois Remote , PRN) to join our...clinical expertise to operations relating to the peer review process, utilization review activities, and other… 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 ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… more
- Kepro (Minneapolis, MN)
- …solutions in the public sector. Acentra is looking for a Utilization Management - Mental Health Clinical Reviewer to join our growing team. This is a Remote ... Summary: The purpose of this position is to utilize clinical expertise to review medical records against...Responsibilities: + Assures accuracy and timeliness of all applicable review type cases within contract requirements. +… more
