- Chenega Corporation (Rockville, MD)
- …Strategic Business Unit** company, is looking for a Nurse Practitioner-Contract Medical Reviewer (CMR) to support the Department of Health and Human Services (HHS), ... programs, or managed care. + Professional Background: Relevant experience in claims review , healthcare administration, or related fields. + A minimum of five years… more
- Chenega Corporation (Rockville, MD)
- …Services Strategic Business Unit** company, is looking for a Physician- Contract Medical Reviewer (CMR) to support the Department of Health and Human Services (HHS), ... clients Rockville, MD location. + Professional Background: Relevant experience in claims review , healthcare administration, or related fields. + A minimum of 10… more
- APTIM (Santa Fe, NM)
- **Summary:** The Mid-Level Claims Reviewer supports the claims process by reviewing, evaluating, and documenting claims for disaster-related losses. This role ... A minimum of five (5) years of combined experience in claims or case processing roles, including customer service, data entry, reviewing, and evaluating various… more
- Liberty Healthcare Corporation (Marion, IN)
- …their dreams. Liberty is now hiring for a full time 'Quality Reviewer ' position which involves investigating complaints regarding services administered by waiver ... degree and experience in the health and human services field - ideally in case management, service coordination, or other relevant work in support of people who have… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address ... explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise interacts with Health… more
- City of New York (New York, NY)
- …Program Evaluator is responsible for the following: - Evaluate contracted provider agency case practice utilizing the standardized PAMS review tool - Compile, ... Agency Measurement System Unit (PAMS) is responsible for conducting comprehensive, annual case record evaluations of all foster care, preventive and Close to Home… more
- BMO Financial Group (Milwaukee, WI)
- …analysis and assessment to resolve strategic issues. + Develops the business case by identifying needs, analysing potential options and assessing expected return on ... data and information to provide insights and recommendations. + Manages review findings and follow up in transparency, consistency, detailed ongoing communications… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address ... explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise interacts with Health… more
- Centene Corporation (Atlanta, GA)
- …a fresh perspective on workplace flexibility. **Position Purpose:** Authorize and review utilization of dental services provided in provider offices, community ... a resource between the health plan, provider relations, and dental providers + Review treatment plans and initial evaluations + Comply with performance measures in… more
- STG International (Rockville, MD)
- STGi is currently seeking a Registered Nurse- Case Review Specialist . The position is remote and open to candidates nationwide. JOB SUMMARY: Provides direct ... and productivity of the Federal workforce by performing fulfillment of case review activities ( review of service and provider fulfillment), interacting… more