- Citizens (Johnston, RI)
- Description The Real Estate & Insurance Risk Reviewer will be the primary reviewer and point of contact with RMs/PMs in the completion of property insurance ... and CLO as Subject Matter Expert in assisting them review a borrower's property insurance package both on annual...those loans that do not require a formal external review . + Transactional oversight of property and casualty insurance… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Bring your true colors to blue. The Role The RN Utilization Management Reviewer is responsible for facilitating care for members who may have complex healthcare ... to provide the best quality care. The Team The RN Utilization Management Reviewer is part of a highly dedicated and motivated team of professionals, including… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …healthcare? Bring your true colors to blue. The Clinical Pharmacist Reviewer reviews formulary exception, prior authorization and quantity limit exception requests ... from providers via phone and fax for the Retail Pharmacy, Medicare Advantage Part D, Home Infusion Therapy, and Medical Utilization Management benefits. This position is eligible for the Flex persona. Local candidates are required to work from the Hingham… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …most appropriate decision within regulatory timeframes.The TeamAs an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a ... true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound clinical judgement to... is responsible for applying sound clinical judgement to review provider and member appeals for denied services according… more
- Trinity Health (Des Moines, IA)
- …Des Moines Join the MercyOne Family! We are looking to hire a Utilization Review RN! Responsible for the review of inpatient and outpatient admission records ... Management staff utilizing admission criteria guidelines-and second level physician review process when appropriate. Interacts with insurance providers to obtain… more
- Rising Medical Solutions (Chicago, IL)
- Rising Medical Solutions seeks a Medical Review Unit Director for our Workers Compensation based products and services. This role is ideal for a seasoned ... patient care and reducing healthcare costs through effective medical review processes. The Medical Review Unit Director will oversee the medical review … more