- Excellus BlueCross BlueShield (Rochester, NY)
- …diagnosis and treatment of members' behavioral 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
- 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
- HonorHealth (AZ)
- …suggestions related to resource and service management, assists staff with the clinical review of patients, determines if professionally recognized standards of ... urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization,… more
- Mohawk Valley Health System (Utica, NY)
- …and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, ... utilization of resources. The Physician Advisor guides the team to improve clinical and financial outcomes with documentation and clinical education. Core… more
- Veterans Affairs, Veterans Health Administration (Spokane, WA)
- …uses Behavioral Health Lab (BHL) software to support efficiency of administration and clinical review . Using the Columbia Suicide Severity Rating Scale (C-SSRS), ... support. Complete Measurement Based Care (ie, PHQ9, GAD7, etc) as part of clinical assessment to assist with determination of placement along the MH Continuum of… more
- Pfizer (Groton, CT)
- …assigned clinical studies. + Provides therapy area/indication expertise in support of clinical review of clinical data - including CRF design, assistance ... and SCS + Support appropriate interpretation and communication of clinical trial data. + Review and approve submission level safety narrative plan. + Supports… more
- CVS Health (Harrisburg, PA)
- …Identify, research, analyze and document analytic leads or referrals to send for investigative review . + Review company clinical and payment policies to ... determine the impact of the scheme on Aetna business. + Keep current with new and emerging fraud, waste, and abuse schemes and trends through training sessions and industry resources. + Communicate with colleagues, verbally and in writing, findings related to… more
- Guardian Life (Plano, TX)
- …management and utilization review , as requested by the Dental Director, Clinical Review . This position will be expected to uphold Guardian's commitment ... **Reporting Relationships** This position reports to the Dental Director, Clinical Review . **Location Requirements** + Theprimarylocationforthispositionisremotewithworkfromhomeflexibility.TraveltoGuardian officesasneeded.… more
- Geisinger (Scranton, PA)
- …related to Cardiovascular Prevention. + Actively participate in the scientific and clinical review of all new pharmacotherapies connected to our Cardiovascular ... risk reduction by Primary Care, Endocrinology and Bariatrics. + Provide review of any clinical quality challenges that arise within the realm of Cardiovascular… more
- Evolent (Helena, MT)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a...MD review process to reflect appropriate utilization and compliance with… more