- Centene Corporation (Baton Rouge, LA)
- …perspective on workplace flexibility. ** Remote opportunity** Centene is seeking a Remote Psychologist Reviewer to join our mission-driven team and make a ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- Zelis (FL)
- …found and justifying the revised choices of new codes and DRG, based on the clinical evidence obtained during the review + Document all aspect of audits ... interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay… more
- The Joint Commission (Oakbrook Terrace, IL)
- …Field Representatives, with minimal direction or supervision, survey and/or review health care organizations throughout the United States. Field Representatives ... **Responsibilities** Position Accountabilities: + Ability to analyze and synthesize survey/ review findings to provide conclusions, recommendations and educational opportunities.… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the diagnosis and treatment of members' medical health conditions, applying established clinical review criteria, guidelines and medical policies and contractual ... benefits as well as State and Federal Mandates. May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental… more
- Centene Corporation (Atlanta, GA)
- …practice that is relevant to the clinical area(s) addressed in the initial clinical review . Pay Range: $26.50 - $47.59 per hour Centene offers a ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- US Tech Solutions (Columbia, SC)
- …or services, and appeals. + Documents decisions using indicated protocol sets or clinical guidelines. + Provides support and review of medical claims and ... **Location: Columbia, SC 29229** **( Remote after training)** **Duration: 3+ Months Contract** **(Possible...any of the following in support of medical claims review and utilization review practices: Performs medical… more
- Zelis (NJ)
- …responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG Quality Assurance reviews in an effort to increase the savings achieved ... records utilizing ICD-10 Official Coding Guidelines, AHA Coding Clinic evidence based clinical criteria and client specific coverage policies. What you'll do: +… more
- UCHealth (Aurora, CO)
- Description This position is an onsite role and does not offer a hybrid or remote option. UCHealth Clinical Quality and Safety Specialist (CQSS) - Safety * ... review and response Location: UCHealth UCHlth Leprino Building AMC, US:CO:Aurora Department: Clinical Quality FTE: Full Time, 1.0, 80.00 hours per pay period… more
- CVS Health (St. Paul, MN)
- …Management. - Refer all cases that do not meet applicable criteria or have a potential quality of care issue to a physician reviewer . - Identify and address ... with heart, each and every day. **This is a remote work from home role anywhere in the US...AHH delivers flexible medical management services that support cost-effective quality care for members. - This position consists of… more
- Cedars-Sinai (Beverly Hills, CA)
- …surpluses. Negotiates with sponsors the final payment due for account closeout. May conduct review and/or audits of clinical trial budgets. Serves as a resource ... trial budget. + Performs Medicare coverage analysis for clinical trials and collaborates with Institutional Review ...improve existing standard operating procedures related to budgeting and clinical trials finance. May identify quality and… more