- US Tech Solutions (May, OK)
- …with unrestricted active license **Responsibilities:** + Reviews documentation and evaluates potential quality of care issues based on clinical policies and ... **Position Summary:** Responsible for the review and evaluation of clinical information and documentation. Reviews documentation and interprets data obtained from … more
- CVS Health (Topeka, KS)
- …with flexible Weekdays **Position Summary** Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for services requiring ... spent at a desk and on the phone collecting and reviewing clinical information from providers. Precertification nurses use specific criteria to authorize… more
- CVS Health (Salt Lake City, UT)
- …working from home anywhere in the US. **Position Summary** + Utilizes clinical experience and skills in a collaborative process to implement, coordinate, monitor ... and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and plan language or policy specifics to render a medical determination to… more
- CVS Health (Santa Fe, NM)
- …1993. We provide flexible, cost-effective care management solutions that promote high- quality healthcare for members. **Position Summary** We are seeking a dedicated ... our remote team. In this role, you'll be at the forefront of clinical decision-making, applying your expertise in Behavioral Health to ensure members receive… more
- US Tech Solutions (Chesapeake, VA)
- …healthcare costs and improve healthcare program/operational efficiency involving clinical issues Determines medical necessity/ appropriateness Facilitates optimal ... outcomes Identifies and follow through with continuous quality / compliance opportunities. May also include identification of aberrance's and initiation of corrective… more
- CVS Health (Olympia, WA)
- …work schedules will include weekends, holidays, and evening hours._ + Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, ... to facilitate appropriate healthcare services/benefits for members. + Gathers clinical information and applies the appropriate clinical criteria/guideline,… more
- KPH Healthcare Services, Inc. (La Crosse, WI)
- **Overview** **Scope of Responsibilities:** Provides a dynamic link between clinical practice and service development to support new models for delivering patient ... as it relates to the provision of the highest quality health care service to our customers **Responsibilities** **Job...time on each resident's review as defined by their clinical needs + Provide quarterly reports reflecting facility-level drug… more
- The Cigna Group (Bloomfield, CT)
- …and intervention. * Uses continuous collaboration consultation on cases to ensure quality service delivery. * Provides clinical review with EAP providers. ... The range of diverse concerns provides an opportunity to apply your clinical expertise and customer support experience on a daily basis. **Responsibilities** *… more
- US Tech Solutions (Atchison, KS)
- …Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. ... Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health… more
- Philips (Cambridge, MA)
- …with a diverse team of internal and external resources to include clinical , sales, and service partners. Coordinate project resources and tasks, enabling team ... documentation, and other related paperwork. Adhere to established training, quality , and safety requirements. + Install complex, multi-phased systems comprised… more