- AmeriHealth Caritas (Washington, DC)
- …to efficiently document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... cases are escalated to the Medical Director for further review . The reviewer independently applies medical and...ability to meet productivity standards in a fast-paced, high-volume utilization review environment + Proficiency using MS… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe RN Utilization Management Reviewer is responsible for facilitating care for members who ... member's benefit to provide the best quality care. The TeamThe RN Utilization Management Reviewer is part of a highly dedicated and motivated team of… more
- Liberty Healthcare Corporation (Annapolis, MD)
- …their best lives. To support this initiative, Liberty is now hiring for a full-time Utilization Reviewer position. As a Utilization Reviewer , your daily ... with developmental disabilities + Service coordination + Case management + Utilization review + Prior authorizations + Claims reviews + Healthcare billing +… more
- Guthrie (Cortland, NY)
- …for those with less than one year of experience) Summary The LPN Utilization Management (UM) Reviewer , in collaboration with Care Coordination, Guthrie Clinic ... Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization/certification for… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …as appropriate. At the request of the Senior Medical Director of the Physician Review Unit (PRU), the reviewer also provides clinical leadership in other areas ... transform healthcare? Bring your true colors to blue. The Role The Physician Reviewer is responsible for evaluating pre & post-service clinical service requests made… more
- Healthfirst (NY)
- **Duties/Responsibilities:** + The Medical Peer Reviewer will assess/ review requests for authorization, and claims payment, based on medical records and internal ... and make informed clinical judgments and recommendations. + The Medical Peer Reviewer will render determinations in the format and within timeframes to follow… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas ... your true colors to blue. The Role The Physician Reviewer is responsible for evaluating clinical service requests made...anticipatory case management for members whose cases come for review , in partnership with case managers + Participate in… more
- Koniag Government Services (Germantown, MD)
- …weapons design, nuclear material production, counterintelligence, weapon science, and military utilization of nuclear weapons to review and assess documents. ... Services, LLC,** a Koniag Government Services company **,** is seeking a Document Reviewer Level 5 (DRL5) with Top- Secret clearance to support **KPS** and our… more
- Koniag Government Services (Germantown, MD)
- …Professional Services** , a Koniag Government Services company, is seeking a Document Reviewer Level 2 (DRL2) with a Top-Secret clearance to support KPS and our ... Services, a Koniag Government Services company, is seeking an experienced Document Reviewer Level 2 (DRL2) to conduct classification reviews of documents and… more
- Koniag Government Services (Germantown, MD)
- …Professional Services** , a Koniag Government Services company, is seeking a Document Reviewer Level 1 (DRL1) with a Top-Secret clearance to support KPS and our ... Services, a Koniag Government Services company is seeking an entry-level Document Reviewer Level 1 (DRL1) to conduct classification reviews of government agency… more
- ChenMed (Miami, FL)
- …to join our team. The Physician Reviewer is the primary physician reviewer for Utilization Management/Clinical Appropriateness review cases in our ... in Hospital medicine preferred + At least one (1) year of utilization review experience preferred **PAY RANGE:** $198,797 - $283,995 Salary **EMPLOYEE BENEFITS**… more
- Hartford HealthCare (Hartford, CT)
- …The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection, documentation, ... multiple time intervals over the course of the patient's care through effective utilization of the hospital and surgeons' office record systems. . Works in… more
- Koniag Government Services (Germantown, MD)
- …Professional Services** , a Koniag Government Services company, is seeking a Document Reviewer Level 3 (DRL3) with a Top-Secret clearance to support KPS and our ... Services, a Koniag Government Services company, is seeking an experienced Document Reviewer Level 3 (DRL3) to conduct classification reviews in accordance with… more
- Centers Plan for Healthy Living (Margate, FL)
- …accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team ... support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine… more
- Carle Health (Peoria, IL)
- …Arts (LPHA) authorizing Integrated Assessment and Treatment Plans. Will complete thorough review of each document, provide clinical guidance to team members, and ... ensure compliance with IATP standards. LPHA reviewer provides behavioral health assessment, intervention, and consultation to individuals and/or groups identified as… more
- Sharp HealthCare (San Diego, CA)
- …of Authorization Review for Sharp Health Plan (SHP). The Physician Reviewer will perform all reasonably necessary functions to ensure quality of care and ... appropriate utilization in the most cost-effective, appropriate and professional manner,...of managed care and the process for prior authorization review . + California Physicians and Surgeons License - Medical… more
- Koniag Government Services (Germantown, MD)
- …Services, LLC,** a Koniag Government Services company, is seeking a Lead Document Reviewer Level 5 (DRL5) with Top- Secret clearance to support **KPS** and our ... design, nuclear material production, counterintelligence, weapon science, and military utilization of nuclear weapons. **Essential Functions, Responsibilities & Duties… more
- Insight Global (New York, NY)
- …preferred - 5-6+ years of clinical practice can be flexible - 1+ years of utilization review experience in a managed care plan (health care industry) - Licensed ... Physician Reviewers for a leading health insurance company. The Physician Reviewer will review requests for care before, during, and after treatment to confirm… more
- Centene Corporation (Indianapolis, IN)
- …licenses as needed. **Join Centene's mission-driven team as a Remote Psychologist Reviewer specializing in Applied Behavior Analysis (ABA) with a focus on ... with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or designee, to… more
- Nuvance Health (Poughkeepsie, NY)
- …Team Leaders via program dashboard on quality and process measures.Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as ... *Description* Summary: *Purpose: *The Quality Systems Reviewer assists in the implementation of the Agencyi? 1/2s Performance Improvement, Risk Management, Infection… more