- Zelis (St. Petersburg, FL)
- …interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay ... AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest savings for… more
- AmeriHealth Caritas (Washington, DC)
- …When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines ... **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient… more
- Staffing Solutions Organization (Charlotte, NC)
- …which is a reflection of our clients and the people they serve. **Onsite Reviewer - Greensboro, NC** (Must live in Greensboro, NC, Charlotte, NC or surrounding ... by the North Carolina Department of Medicaid. The Onsite Reviewer will operate on a solo basis, within a...quality, and customer-service standards). + Work as a solo reviewer and be able to self-manage deadlines and timelines.… more
- AmeriHealth Caritas (Lafayette, LA)
- …and providers to collect all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer 's discretion to retain ... direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical necessity reviews. Using clinical… more
- Evolent (Helena, MT)
- …Join a mission with a company behind it. **What You'll Be Doing:** As a Clinical Reviewer , Nurse, you will be a key member of the utilization management team. We can ... providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse, you will routinely interact with leadership and...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Evolent (Helena, MT)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Clinical Reviewer , Nurse, you will be a key member of the utilization management team. We can ... providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse, you will routinely interact with leadership and...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Centene Corporation (Harrisburg, PA)
- …claim reviews to ensure compliance with coding guidelines through a comprehensive review and analysis of claims, medical records, claims history, state regulations, ... state fair hearings and health plan provider calls. + Develop and maintain review guidelines for Corporate medical coding reviews. + Performs other duties 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 ... care physician with knowledge of managed care and the process for prior authorization review . + California Physicians and Surgeons License - Medical Board of CA -… more
- Liberty Healthcare Corporation (Waldorf, MD)
- …are encouraged to consider a unique career opportunity and available Quality Reviewer position with Liberty Healthcare. Liberty Healthcare's mission is to utilize ... outcomes for people living with intellectual and developmental disabilities. As a Quality Reviewer , you will be an active contributor in this exciting and impactful… more
- Centene Corporation (Jefferson City, MO)
- …Unit** **ed States.** **Position Purpose:** Perform clinical/coding medical claim review to ensure compliance with coding practices through a comprehensive ... review and analysis of medical claims, medical records, claims...directives, precedent, AMA and CMS code edit criterion + Review medical records to ensure billing is consistent with… more