- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- Centene Corporation (Phoenix, AZ)
- …benefits including a fresh perspective on workplace flexibility. Centene is seeking a ** Clinical Review Nurse** to join our **Arizona Medicaid team** in 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
- UPMC (Bridgeville, PA)
- UPMC Rx Partners is looking for a full time Pharmacy Clinical Review Specialist to join their dedicated team! This position provides prescription data entry and ... provides customer service to Rx Partners Skilled nursing and Hospice clients. The clinical review specialist at Rx Partners works hand in hand with a licensed… more
- Hackensack Meridian Health (Edison, NJ)
- …transform healthcare and serve as a leader of positive change. The **Sleep Clinical Review Technician** is responsible for clinical history, signs/symptoms, ... diagnosis code and test order review . Works directly with team members and ordering clinicians and their staff to educate and support appropriate documentation for coding, authorizations and appropriate testing. This position will offer a hybrid schedule.… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- Abbott (Maple Grove, MN)
- …diabetes from routine fingersticks. **The Opportunity** We are looking for our next **Manager, Clinical Data Review ** to lead our team on-site out of our Maple ... execute processes; continually evaluate their effectiveness and appropriateness. The Manager, Clinical Data Review will exercise judgment in planning, organizing… more
- HCA Healthcare (Plano, TX)
- **Description** **Introduction** Do you have the career opportunities as a Clinical Denial Coding Review Specialist you want with your current employer? We have ... caring group of colleagues. Do you want to work as a Clinical Denial Coding Review Specialist where your passion for creating positive patient interactions is… more
- Centene Corporation (New York, NY)
- …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, ... and cost effectiveness of medical care. + Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in… more
- UCLA Health (Santa Monica, CA)
- …for the identification, collection, and entry of quality data for the Clinical Registries, Patient Safety Indicators (PSIs), and Hospital Acquired Conditions (HACs) ... program. This will involve applying your clinical knowledge to analyze data and identify trends and...improvement. You will serve as a liaison between the clinical stakeholders, clinical registries, and outsourced registry… more
- Centene Corporation (Trenton, NJ)
- …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, ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more