- Albany Medical Center (Albany, NY)
- …in quality processes. + Meets with physician leaders to assure clinical quality expectations are being met or exceeded. Education/Licensure Requirements + ... States of America) Salary Range: $78,773.63 - $122,099.12 The Manager of Radiology Quality is responsible for managing all aspects of the Department Quality … more
- HCA Healthcare (Austin, TX)
- …Contributes to the company's mission and vision by supporting and coordinating clinical performance in assigned market(s). The Quality Program Manager works ... and agenda. + Provides leadership and directs effort for clinical and quality improvement in addition to...personal growth, we encourage you to apply for our Quality Program Manager opening. We promptly review … 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
- Healthfirst (NY)
- **Duties//Responsibilities:** + The Medical Peer Reviewer will assess// review requests for authorization, and claims payment, based on medical records and ... make informed clinical judgments and recommendations. + The Medical Peer Reviewer will render determinations in the format and within timeframes to follow… more
- GRAIL (Durham, NC)
- …including Corrective and Preventive Action (CAPA) investigations, Nonconformance (NCR) reporting, Quality Management Review (QMR), clinical laboratory ... Quality Indices (QI). This role also supports Change Control, Quality Planning, clinical laboratory licensure/certification, internal and external audits,… more
- Naven Health (Nashville, TN)
- …Assurance Chart Review Nurse is responsible for the review of assigned clinical records. The Quality Assurance Chart Review Nurse works closely with ... and deficiencies in the patient's clinical records. The Quality Assurance Chart Review Nurse utilizes audit tools and systems to collect data for… more
- AmeriHealth Caritas (Lafayette, LA)
- …clinical criteria. Using professional judgment, the Utilization Management Reviewer assesses the appropriateness of services, identifies care coordination ... When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines… more
- Hartford HealthCare (Wethersfield, CT)
- …moment. * **Job:** **Nursing* **Organization:** **Hartford HealthCare Medical Group* **Title:** * Clinical Operations Resource Registered Nurse (RN) - Quality and ... Under the supervision of Director of Nursing , the Clinical Operations Resource Nurse a Registered Nurse (RN) with...an ambulatory care setting with demonstrated experience in skill review and employee mentoring or, 3 years of inpatient… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas of BCBSMA. The ... your true colors to blue. The Role The Physician Reviewer is responsible for evaluating clinical service...anticipatory case management for members whose cases come for review , in partnership with case managers + Participate in… more
- NTT DATA North America (IL)
- …Participates in the collection and review of medical records to abstract clinical information for HEDIS quality reporting. Training will be provided prior to ... the start of the assignment. This position interprets relevant clinical criteria through review of medical records, annotates via Adobe PDF and populates a data… more