- Magellan Health Services (Honolulu, HI)
- …Project management skills and demonstrated experience. General Job Information Title Quality Clinical Reviewer - Remote Grade 25 Work Experience - ... and external reporting. Interacts with multiple stakeholders internally and externally. Provides clinical reviews of Quality of Care (QOC) and Critical/Adverse… more
- Trinity Health (Livonia, MI)
- …months of hire **Trinity Health at Home is seeking an experienced RN Clinical Quality Review Specialist - REMOTE ** **Position Summary** The Clinical ... Trinity Health at Home is seeking an experienced RN Clinical Quality Review Specialist with...Quality Review Specialist is a remote position, responsible for processing and completing assigned … 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
- 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
- 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
- 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
- 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)
- …clinical protocols; and authorizing coverage of services or referring requests for expert clinical review as appropriate. + Be available as an expert advisor ... a supervisor in Utilization Management. Handles moderately complex medical review , utilization review , credentialing/re-credentialing, quality … more
- Pfizer (New York, NY)
- The Clinical Data Reviewer (CDR) is highly specialized to perform clinical data review , most often in a submission timeline. The studies supported by the ... RESPONSIBILITIES + The CDR is routinely responsible for the clinical data review of one or more...data under often challenging timelines. + Familiar with Oracle Clinical Remote Data Capture and/or other database… 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
- Magellan Health Services (Honolulu, HI)
- …facilities, develops discharge plans and oversee their implementation. + Performs quality clinical reviews while educating and making appropriate interventions ... 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
- 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
- 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
- Zelis (TX)
- …found and justifying the revised choices of new codes and DRG, based on the clinical evidence obtained during the review + Document all aspect of audits ... Position Overview: The Inpatient DRG Reviewer will be primarily responsible for conducting post-service,...industry standard inpatient coding guidelines and rules, evidence based clinical criteria plan, and policy exclusions. Conduct reviews on… more
- US Tech Solutions (May, OK)
- …Participates in the collection and review of medical records to abstract clinical information for HEDIS quality reporting. Training will be provided prior to ... Job Title: HEDIS Reviewer II Location: Remote Duration: 7...Duration: 7 months Job Description: This position interprets relevant clinical criteria through review of medical records,… more
- System One (Copley, OH)
- Title: Medical Reviewer Location: Remote - must be available to work on EST hours Pay Rate: $80+/hr, commensurate with experience Type: contract (renewable) ... direct patient care + 3 years minimum in post-licensure clinical practice (residency or fellowship does not count) +...get work done more efficiently and economically, without compromising quality . System One not only serves as a valued… more
- Bristol Myers Squibb (Summit, NJ)
- …1 pm - 11 pm **Responsibilities:** + Supports all activities for the Quality Operations Investigations group. + Review and approve Site operational ... + Review and approve Supplemental actions. + Review and approve Impact assessments or Product Quality...unique perspectives in an inclusive culture, promoting diversity in clinical trials, while our shared values of passion, innovation,… more