- Pfizer (Collegeville, PA)
- …supports preparations for Health Authority meetings, participates as appropriate . Set the clinical data review strategy and leads the team in the collection ... of quality data and review of emerging clinical data and trends; reviews and queries data; presents and discusses relevant data to appropriate teams , governance… more
- Pfizer (Collegeville, PA)
- …in external engagements or as committee member in joint collaborations. Collaborate with Clinical Scientists to review and interpret clinical data, identify ... within the atirmociclib program. This individual contributor will be responsible for supporting clinical trial(s) and lead sub teams in clinical development. The… more
- Evolent (Harrisburg, PA)
- …the mission. Stay for the culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer , Nurse, you will be a key member of the utilization ... while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse, you will routinely interact...**What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases,… more
- St. Luke's University Health Network (Bethlehem, PA)
- …of a patient's ability to pay for health care. The Admission's Clinical Reviewer is responsible for the comprehensive medical review and screening of all ... and responds to all inquiries for admission to ARC + Completes thorough review of documentation and information and assesses a patient's appropriateness for ARC… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview: ;** The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory ... a case for determination, interacting directly with providers to obtain additional clinical information, and with members or their advocates to understand the full… more
- Evolent (Harrisburg, PA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- Trinity Health (Newtown Square, PA)
- …clinical and coding expertise to direct efforts toward the integrity of clinical documentation through the roles of reviewer , educator, and consultant. ... **Description:** Trinity Health Mid-Atlantic, is looking for a CIN Ambulatory Clinical Documentation Specialist to join our team! **Employment Type:** Full Time… more
- UPMC (Pittsburgh, PA)
- UPMC Health Plan is looking for Pharmacy Clinical Review Specialist I positions in the Pharmacy Services department. This is a full time position working Monday ... through Friday 11:30am to 8:00pm and weekend rotations. The Clinical Review Specialist will oversee administrative and system processes that relate to pharmacy… more
- Geisinger (Danville, PA)
- …through presentations at national meetings, service on study sections or ad hoc grant review committees, and peer reviewer for journals. + Takes a lead role ... and Center for Kidney Health Research is seeking to expand its growing clinical research program by adding a BC Nephrologist with an established history of… more
