- Commonwealth of Pennsylvania (PA)
- Clinical Care Reviewer (County Care Management Manager) (Local Government) - Fayette County MH/ID Print ... (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5058227) Apply Clinical Care Reviewer (County Care Management Manager) (Local Government) -… more
- Hartford HealthCare (Hartford, CT)
- …different specialties. The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely ... data registry activities, including program teleconferences and meetings. Maintains Surgical Clinical Reviewer (SCR) certification on an annual basis, in… more
- Evolent (Frankfort, KY)
- …the mission. Stay for the culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer , Nurse, you will be a key member of the utilization ... while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse, you will routinely interact...**What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases,… more
- Evolent (Helena, MT)
- …mission. Join a mission with a company behind it. **What You'll Be Doing:** As a Clinical Reviewer , Nurse, you will be a key member of the utilization management ... while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse, you will routinely interact...**What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases,… more
- BJC HealthCare (St. Louis, MO)
- …relevant work experience) **Additional Information About the Role** BJC is hiring for a Surgical/ Clinical Reviewer . This is a remote position. Must be located in ... medical schools in the country. **Preferred Qualifications** **Role Purpose** The Surgical Clinical Reviewer (SCR) is responsible for abstracting and sharing… more
- St. Luke's University Health Network (Bethlehem, PA)
- …of a patient's ability to pay for health care. The Admission's Clinical Reviewer is responsible for the comprehensive medical review and screening of all ... and responds to all inquiries for admission to ARC + Completes thorough review of documentation and information and assesses a patient's appropriateness for ARC… more
- Centers Plan for Healthy Living (Margate, FL)
- …applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …us transform healthcare? Bring your true colors to blue. The Role The Clinical Pharmacist Reviewer reviews formulary exception, prior authorization and quantity ... Network and Medical Utilization Management for pharmaceuticals programs + Partner with clinical and non- clinical teams for staff training, facilitation of… more
- AmeriHealth Caritas (Washington, DC)
- …SIGN ON BONUS** **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for ... on clinical criteria. Using professional judgment, the Clinical Care Reviewer assesses the appropriateness of...cases are escalated to the Medical Director for further review . The reviewer independently applies medical and… more
- AdventHealth (Orlando, FL)
- …year **The role you'll contribute:** Under general supervision of the Director of Clinical Documentation Integrity and in some situations the supervision of the ... Clinical Documentation Integrity Manager, and in collaboration with physicians,...with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality… more
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