- CVS Health (Columbus, OH)
- …role in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position ... in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and plan… more
- Sedgwick (Cedar Rapids, IA)
- …need for absence from work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims; documents decision rationale; and ... Fortune Best Workplaces in Financial Services & Insurance Disability Clinical Specialist **PRIMARY PURPOSE** : To perform clinical...completes medical review of all claims to ensure information substantiates disability.… more
- Trinity Health (Springfield, MA)
- …weekly supervision of Clinical Case Coordinators and provides supervision to the clinical team during clinical review meetings. + Reviews treatment goals ... Health Of New England is looking for an experienced ** Clinical Case Supervisor** to come join our team. Brightside...by being there to offer support and encouragement. The ** Clinical Care** **Supervisor** **is a master's Level and Licensed… more
- Texas Health Resources (Arlington, TX)
- …Remote (Local candidates only) Work hours: Monday - Friday from 8:00am - 4:30pm Clinical Review and Denials Department highlights: + Flexible schedule + Remote ... Clinical Reviews, Denial and Appeals RN Bring your...necessary research for appealing denied days/stays through electronic record review . Requires access to Care Connect patient records for… more
- Houston Methodist (Houston, TX)
- …Collaborates with revenue cycle regarding any claim issues or concern that may require clinical review during the pre-bill, audit, or appeal process. + Secures ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed...delivery settings and recommends alternatives, if appropriate, by analyzing clinical protocols. Reviews H&Ps and admitting orders of all… more
- Healthfirst (NY)
- …work experience** **NYS RN** **Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care operations** **Leadership ... management for all utilization management functions, including prior authorization, concurrent review , and service requests** **Lead, coach, and develop UM managers… more
- UC Health (Cincinnati, OH)
- …of direct support personnel who are completing precertification and follow up work through clinical review , appeal letters, and provision of drug information or ... Services Hours: Full-Time, 40 Hours/Weekly Shift: First UC Health is hiring a Clinical Staff Pharmacist for the Medication Access Services Pharmacy Department at the… more
- Centene Corporation (Sacramento, CA)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and ... the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and ability to review and/or assess treatment plans… more
- Centene Corporation (San Diego, CA)
- …8 pm (CST)** **Remote - CA or Remote - TX** **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse. ... Management related to Behavioral Health case is preferred + Clinical knowledge and ability to review and/or assess treatment plans related to mental health and… more
- Health Advocates Network (Brooklyn, NY)
- …the initial evaluation + Conducts clinically sound risk evaluations including clinical review , applying risk assessment protocols, pertinent data/chart reviews, ... Health Advocates Network is seeking a **Licensed Clinical Social Worker (LCSW)** to work at a...assess, diagnose and manage the presenting symptoms + Writes clinical reports regarding diagnoses and prognoses and develops treatment… more