- US Tech Solutions (May, OK)
- …or denied prior authorizations. **Responsibilities:** + Ensure accuracy of case setup and clinical review of Medicare appeals cases. + Review internal ... **Duration:** 6 months contract **Job Description:** + The clinical pharmacist is an operation based role that...for the Specialty Pharmacy programs administered within the Case Review Unit. + Performs other related projects and duties… more
- State of Georgia (Richmond County, GA)
- …and guidance issued by the Office of Behavioral Health Services. + Conducts a Clinical review of mental health documentation on a bimonthly schedule to evaluate ... policy and guidelines issued by the Office of Behavioral Health Services. + Review background information available in JTS and the youth's health record. + Interview… more
- Penn Medicine (Philadelphia, PA)
- …records for accuracy and to filter out duplicates prior to routing for clinical review . Utilizing scanners and scanning software, uploads all pertinent documents ... for accuracy and to filter out duplicates prior to routing for clinical review . Utilizing scanners and scanning software, uploads all pertinent documents into… more
- Sanofi Group (Morristown, NJ)
- …manager to prepare and interpret feasibility and competitive intelligence results + Review and provide clinical input across different study documents Vendors ... clinical data through continuous data validation, blinded Data review on summary tables or electronic data visualization during... on summary tables or electronic data visualization during clinical trial conduct (AE dedicated review , and… more
- Nuvance Health (Danbury, CT)
- …for appropriateness of hospitalization, LOC status, LOS management, continued stay decisions, clinical review of patients, utilization review activities, ... knowledge of regulatory and accreditation requirements related to utilization review (UR) LOC and clinical documentation. *...related to utilization review (UR) LOC and clinical documentation. * Conducts verbal and written Peer to… more
- CVS Health (Raleigh, NC)
- …reporting to align local efforts with state and national quality goals. **Key Responsibilities** ** Clinical Review & Compliance** + Review and evaluate ... combines clinical expertise with quality improvement leadership, including clinical documentation review , Performance Improvement Projects (PIPs), ANE… 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 ... the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management, you will be a...MD review process to reflect appropriate utilization and compliance with… more
- Evolent (Helena, MT)
- …utilization management with collaborative engagement and innovation. **Core Responsibilities** + ** Clinical Review & Peer Collaboration** + Serve as the ... play a pivotal role in advancing value-based care models that prioritize clinical excellence, patient-centered outcomes, and system-wide impact. This role offers the… more
- Veterans Affairs, Veterans Health Administration (New York, NY)
- …reviews in accordance with VHA guidelines. Reports adverse events and participates in clinical review processes as required. Preferred 2-3 years of NP experience ... Mental Health Primary Care, Medical, Surgical in both inpatient and outpatient clinical settings to provide a full range of services emphasizing quality, timeliness,… more
- Bozeman Health (Bozeman, MT)
- …and delivery of clinical and distributive services. Primary duties include: clinical review and order verification, following pharmacy clinical ... and relays questions and concerns to pharmacy super trainer group. Clinical review and verification of provider orders. Maintains competency and demonstrates… more