- Magellan Health Services (Boise, ID)
- …minimal supervision. Project management skills and demonstrated experience. General Job Information Title Quality Clinical Reviewer ( Remote - Must live ... and external reporting. Interacts with multiple stakeholders internally and externally. Provides clinical reviews of Quality of Care (QOC) and Critical/Adverse… more
- BD (Becton, Dickinson and Company) (Franklin Lakes, NJ)
- …and become your best self. Become a **maker of possible** with us. The **Sr. Clinical Quality Specialist** is responsible for supporting the Global Clinical ... and advance compliance issues to the Senior Manager of Clinical Quality and other relevant leadership, including...address ad hoc business unit needs and issues + Review key study documents (eg, Clinical Investigation… more
- Merck (Columbus, OH)
- …quality data from clinical trials conducted worldwide. In collaboration with the Clinical Quality Operations Lead {CQOL and Head of Clinical ... Quality Operations (HCQO), the Clinical Quality Operations Manager (CQOM)} is responsible for the execution...periodically (eg quarterly) perform a Therapeutic Area (TA) level review of quality plans and risk mitigation… more
- University of Miami (Hialeah, FL)
- … this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Concurrent Quality Reviewer of our hospital reviews ... CDIs, Coders, Quality , and other relevant multidisciplinary teams. The concurrent inpatient quality reviewer will assign a working DRG, as well as capture… more
- Kepro (Anaheim, 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 ... Acentra seeks a Utilization Clinical Reviewer to join our growing...a focus on meeting production targets and maintaining top-tier quality assurance standards, this role serves as the linchpin… more
- Kepro (AR)
- …Preferred Qualifications/Experience: + Utilization Review /Utilization Management experience. + Clinical quality review experience with medical records. ... health solutions in the public sector. Acentra is looking for a Clinical Reviewer - Behavioral Health - PRN ( Remote within Arkansas) ** The selected… 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
- Magellan Health Services (Baton Rouge, LA)
- …management according to medical necessity criteria. General Job Information Title Clinical Reviewer III (Baton Rouge, LA or Remote in LA) Grade 26 Work ... other clinical staff. + Provides training, interpretation and support for QI Clinical Reviewer staff. + Audits and validates internal audit results and/or… more
- HCA Healthcare (Corpus Christi, TX)
- …step in your career path, we encourage you to apply for our Registered Nurse Clinical Reviewer opening. We review all applications. Qualified candidates will ... you have the career opportunities as a(an) Registered Nurse Clinical Reviewer you want in your current...including Core Measure chart abstraction, Stroke & STEMI chart review and coordination; performs concurrent chart reviews & is… more
- The Cigna Group (Bloomfield, CT)
- …to Care Managers, Clinical Managers, Providers and other Peer Reviewers in clinical quality improvement process. + Acts as behavioral health consultant in ... Performs peer review and case management activities. Delivers clinical expertise to the organization through peer review , decision making, training,… more
- HCA Healthcare (Corpus Christi, TX)
- …step in your career path, we encourage you to apply for our Registered Nurse Clinical Reviewer PRN opening. We review all applications. Qualified candidates ... you have the career opportunities as a(an) Registered Nurse Clinical Reviewer PRN you want in your...Medical Center Bay Area!** **Job Summary and Qualifications** **The Quality Review Nurse position encompasses multiple responsibilities… 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 ... position Job Summary: The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with… 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 ... PeaceHealth is seeking a RN Clin Doc Integrity Specialist/Denial Reviewer for a Full Time, 1.00 FTE, Day position....and + Preferred: Knowledge of value-based purchasing and other quality metrics affecting the clinical documentation integrity… more
- Zelis (NJ)
- Position Overview: At Zelis, the Itemized Bill Review Facility Reviewer is responsible for analyzing facility inpatient and outpatient claims for Health Plans ... be responsible for developing new concepts, assisting with the quality assurance program, and being a resource for the...overall claims progression + Complete claims processing after the Clinical Bill Review and Audit analysis is… more
- SSM Health (MO)
- …(CDI) specialist is responsible for facilitating the improvement in the overall quality and completeness of provider-based clinical documentation in the medical ... **It's more than a career, it's a calling** MO- REMOTE **Worker Type:** Regular **Job Highlights:** At SSM...the level of services rendered. The CDI Specialist assesses clinical documentation through extensive review of the… 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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Your Day to Day : + Conduct pre-certification and concurrent and retrospective clinical review of in-state and out-of-state inpatient cases at acute residential ... Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating...by providers that include treatment goals, interventions, and expected clinical outcomes and that support quality and… more
- ManpowerGroup (Columbia, SC)
- **Job Title: Medical Claims Reviewer ** **Pay Rate:23/Hr ( REMOTE opportunity after training)** **Duration:3+ Months on W2** **Location:4101 Percival Road Columbia ... in the state of hire. **Job Description:** As a Medical Claims Reviewer /Utilization Management Specialist, you will be responsible for conducting medical reviews… more
- Bristol Myers Squibb (Indianapolis, IN)
- …RayzeBio, a Bristol Myers Squibb company, is seeking applicants for a Data Reviewer to support the review of laboratory data generated from microbiological ... a detail-oriented individual who will work closely with lab personnel, quality assurance, and other cross-functional teams to ensure accuracy, completeness, and… more
- Medical Mutual of Ohio (OH)
- …you the flexibility to work at home. **Responsibilities** + Evaluates clinical information using established national decision support criteria, company policies, ... implements, and documents, discharge planning activities based on the members' specific clinical condition, health plan benefits, and optimal care delivery. Acts as… more