- St. George Tanaq Corporation (Phoenix, AZ)
- Dispute Resolution Reviewer III Fully Remote*GA Job Type Full-time Description **Overview** Tanaq Support Services (TSS) delivers professional, scientific, and ... community and shareholders. **About the Role** We are seeking a **Dispute Resolution Reviewer III (DRR III)** to support a contract with our federal client. The… 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 ... expert for member and provider submitted appeals. Working collaboratively with Physician review unit, Utilization Management, Case Management, Member appeals and… more
- BJC HealthCare (St. Louis, MO)
- …Surgeons National Quality Improvement Program (ACS NSQIP). This is accomplished through case inclusion screening, clinical chart review with application of ACS ... About the Role** BJC is hiring for a Surgical/Clinical Reviewer . This is a remote position. Must be located...correct application of the program's randomization protocol and timely case completion prior to registry lock dates. + Establishes… more
- Commonwealth Care Alliance (Boston, MA)
- …to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical and service authorization ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS compliance standards in the… more
- Conduent (Alexandria, VA)
- …individuality is noticed and valued every day. **Pharmacist - Claims Auditor/ Reviewer (Part-Time)** **Conduent Payment Integrity Solutions** **Are you a licensed ... of major healthcare payers. As a **Pharmacist - Claims Auditor/ Reviewer ** , you'll apply your clinical knowledge and regulatory...with pharmacies and clients about audit outcomes + Preparing case summaries and serving as a subject matter expert,… more
- Kelly Services (Plainsboro, NJ)
- **Pharmacovigilance QC Reviewer II** Location: Plainsboro, NJ Schedule: Hybrid role with at least 3 days/week onsite is expected Length 1 year Pay: 28:00 **Job ... Requirements:** * In-depth pharmacovigilance case handling from case intake to submission of Individual Case Safety Reports (ICSRs) * Extensive quality… more
- Magellan Health Services (Somerset, PA)
- …reviews of clinical interactions and clinical documentation including reviews of case management records and provider treatment records. Collects data following ... Critical/Adverse incidents related to clinical services. + Audits and reviews case manager and provider clinical documentation and telephone interactions against… more
- Guthrie (Troy, PA)
- …a $15,000.00 Sign on Bonus! Summary The LPN Utilization Management (UM) Reviewer , in collaboration with Care Coordination, Guthrie Clinic offices, other physician ... collaborative relationships with members of the healthcare team. + Proactively researches case findings related to payer audits of UM decisions and prepares input… more
- SSM Health (MO)
- …the patient condition in the associated Diagnosis Related Group (DRG) assignments, case -mix index, severity of illness (SOI), and risk of mortality (ROM) profiling, ... the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate diagnosis review group (DRG) assignment, risk of mortality (ROM), and severity of… more
- The Cigna Group (Bloomfield, CT)
- …is responsible for the following: + Laboratory molecular and genetic testing clinical case review activities. + Evaluate telephone, fax, or web requests for ... protocols; and authorizing coverage of services or referring requests for expert clinical review as appropriate. + Be available as an expert advisor for physicians… more