- Evolent (Austin, TX)
- …Stay for the culture. **What You'll Be Doing:** As an Occupational Therapist, Clinical Reviewer you will be a key member of the utilization management team. We can ... needed or required. Job Summary Functions in a clinical review capacity to evaluate all cases, which do not...an approval cannot be rendered to the Physician Clinical Reviewer . In States where allowed, will make denial determinations… more
- Elevance Health (Grand Prairie, TX)
- …unless an accommodation is granted as required by law._ The **Psychologist Reviewer ** - **part time** is responsible for collaborating with providers and ... Medical Directors to determine appropriateness of level of care based on Medical Necessity Criteria. Outpatient levels of care include Psychological Testing and… more
- Evolent (Austin, TX)
- …Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review rationales and determinations. ... the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are… more
- Health Care Service Corporation (Richardson, TX)
- …reviews in accordance with the medical contract and regulations, medical criteria, utilization review , and quality of care. **JOB REQUIREMENTS** ... obtain multi-state licenses. **PREFERRED JOB REQUIREMENTS** **:** + Utilization review or utilization management experience + Insurance Industry experience.… more
- Evolent (Austin, TX)
- …improvement functions under the auspices of the office of the Chief Medical Officer. ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following. Other duties may ... patients as directed by the office of the Chief Medical Officer. + Responsible for clinical conversations with providers...to ensure client satisfaction. + Perform all peer clinical review activities while located in a state or territory… more
- Evolent (Austin, TX)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a meaningful… more
- Evolent (Austin, TX)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... culture. **What You'll Be Doing:** As a Physician Clinical Reviewer , Interventional Pain Management, you will be a key...reviewing cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
- Oracle (Austin, TX)
- …Regulatory Scientist to provide deep regulatory and scientific leadership for AI-enabled medical device solutions. This role sits within HDI's Regulatory & ... Medical Device organization. You will serve as a senior...lived both sides of the process - as a reviewer and as a submitter - bringing real-world regulatory… more
- Molina Healthcare (Houston, TX)
- JOB DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal ... years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), claims… more
- Terracon (Midland, TX)
- …of plans and specifications, observation and inspection, and the writing, preparation, and review of related reports for the services provided. Review drawings ... and recommend changes. Research and resolve design and construction problems. Assign, review , and evaluate laboratory or field data for inclusion in reports. Apply… more
Recent Jobs
-
Fluoropolymer Extrusion Engineer (Onsite)
- Cordis (Miami Lakes, FL)
-
Sawyer Elementary General Education Associate
- Ames Community School District (Ames, IA)
-
Dispatcher
- Transit Technologies (Phoenix, AZ)
-
Senior Manufacturing Engineer
- Eaton Corporation (Sumter, SC)