- Merck & Co. (North Wales, PA)
- …Scientist in Biomarker Policy to manage biomarker samples and ensure compliant utilization of clinical participant biospecimens to answer scientific questions ... related experiencePreferred Experience and Skills:Sample Management experience, preferably with clinical trial specimensInformed consent authoring and/or review … more
- Merck & Co. (Rahway, NJ)
- …of clinical trials and/or observational studiesProvide guidance, create and/or review dossiers to be submitted to Regulatory Authorities and/or Health Technology ... Principal Scientist has responsibility for supporting or co-leading global Clinical Outcomes Assessment (COA) endpoint strategies, including Patient-Reported Outcomes… more
- Kepro (Anaheim, CA)
- Acentra seeks a Utilization Clinical Reviewer to join our growing team in California. Job Summary As a Utilization Clinical Reviewer , you'll ... the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process in alignment with the California Mental Health...a pivotal role in upholding industry benchmarks. This full-time Clinical Reviewer Remote position based… more
- CVS Health (Frankfort, KY)
- …health care more personal, convenient and affordable. **Position Summary** This is a fully ** remote ** Utilization Review Clinical Consultant with a ... the standard schedule based on business needs **Preferred Qualifications** + Managed care/ utilization review experience + Ability to multitask, prioritize and… more
- Kepro (Minneapolis, MN)
- …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 contract… 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 ... utilization management team, and provides timely medical review of service requests that do not initially meet...clinical determinations cannot be made by the Initial Clinical Reviewer . + Discusses determinations with requesting… more
- The Cigna Group (Bloomfield, CT)
- …in Utilization Management. Handles moderately complex medical review , utilization review , credentialing/re-credentialing, quality assurance/improvement, ... clinical protocols; and authorizing coverage of services or referring requests for expert clinical review as appropriate. + Be available as an expert advisor… more
- Magellan Health Services (Honolulu, HI)
- …Hawaii. Under general supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and ... 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
- ManpowerGroup (Columbia, SC)
- …of medical claims review processes, medical necessity guidelines, and utilization review practices. + Proficiency in medical terminology, coding procedures, ... **Job Title: Medical Claims Reviewer ** **Pay Rate:23/Hr ( REMOTE opportunity after...services. + Ensure thorough documentation of each determination for utilization or claims review . + Review… more
- US Tech Solutions (Columbia, SC)
- …decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. + May provide any of ... equipment to be prepared. + The position is fully remote after that. + Please list out the top...sets/qualities: I would love to have someone with prior insurance/ utilization review experience, but I know that… more
- Centene Corporation (Tampa, FL)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... monitor care for behavioral health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and… more
- Actalent (San Bernardino, CA)
- Description: As a part of the Utilization Management team the Utilization Review RN is a member of the Care Coordination team. The goal of care coordination ... to acute inpatient stay and post-acute facility stay. The Utilization Review RN Coordinates continuing care/outside services...Acute Outpatient experience - Five or more (5+) year's clinical experience required. - Three to five (3-5) years… more
- VNS Health (Manhattan, NY)
- …- $130,800.00 Annual * Reviews specific utilization issues or requests with Clinical Review team, focusing on problem solving, response to actual or ... settings. * Manages and evaluates staff in delivery and coordination of utilization management review services in compliance with CMS guidelines and… more
- CareFirst (Baltimore, MD)
- …coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts, ... **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective,… more
- Elevance Health (Mason, OH)
- …requirements:** + Requires a HS diploma or equivalent and a minimum of 2 years of clinical or utilization review experience and minimum of 1 year of managed ... **LOCATION** **: This is a remote position, but you must reside within 50...through Friday, 10:30 - 7:00 Eastern time** The **Licensed Utilization Review II** responsible for working primarily… more
- Centene Corporation (Indianapolis, IN)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and ... Complies with all policies and standards **This is a remote position. Candidates must have Indiana clinical ...abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare ... by the applicable state required. Master's degree for behavioral health clinicians required. Behavioral health clinical knowledge and ability to review and/or… more
- R1 RCM (Salt Lake City, UT)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse** , you will help our hospital ... in this role, you must have experience in a clinical inpatient environment and hospital-based utilization or...position. **Here's what you will experience working as a Utilization Review Nurse:** + Perform initial admission… more
- Providence (Kodiak, AK)
- …for discharge planning, admission to swing bed and case management including utilization review in accordance with Providence philosophy, objectives, policies, ... and standards. The Case Manager/RN Navigator partners with the Utilization Review nurse, patients, physicians, and interdisciplinary...best people, we must empower them. **This is a Remote position job opportunity! Schedule is part time, 0.5… more
- Elevance Health (Columbus, OH)
- …outpatient precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible for ... ** Utilization Management Representative I** **Location** : This is a remote position. Ideal candidates will live within 50 miles of an Elevance Health PulsePoint… more
