- Cook Medical (West Lafayette, IN)
- …Scientific Communications Medical Reviewer to join our growing Scientific Communications/ Clinical team. Medical Reviewers provide medical review of documents ... 9-to-5 Eastern Standard Time schedule (Monday through Friday). Responsibilities Provide medical review of clinical and certain regulatory documents (including … more
- Zelis (St. Petersburg, FL)
- …found and justifying the revised choices of new codes and DRG, based on the clinical evidence obtained during the review + Document all aspect of audits ... interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay… more
- NTT DATA North America (IL)
- …Reviewer - State of IL Position Summary: Participates in the collection and review of medical records to abstract clinical information for HEDIS quality ... to the start of the assignment. This position interprets relevant clinical criteria through review of medical records, annotates via Adobe PDF and populates a… more
- Elevance Health (Cerritos, CA)
- The **Therapy Services Reviewer ** is responsible for the review of medical records to determine if requests for therapy services (physical therapy, occupational ... regulations and requirements. . Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary. . Acts as a resource… more
- Catalent Pharma Solutions (St. Petersburg, FL)
- **Senior QA Technical Reviewer ** **Position Summary** This position is responsible for the overall Quality Assurance review of all technical documents, as they ... Manufacturing pharmaceutical operation. + Prior experience working with technical review , investigation writing, including root cause analysis and report writing… 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
- The Joint Commission (Oakbrook Terrace, IL)
- …Field Representatives, with minimal direction or supervision, survey and/or review health care organizations throughout the United States. Field Representatives ... **Responsibilities** Position Accountabilities: + Ability to analyze and synthesize survey/ review findings to provide conclusions, recommendations and educational opportunities.… more
- Centene Corporation (Richmond, VA)
- …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, ... occasional peer-to-peer consultations, as well as participating in Utilization Management clinical rounds.** **We're seeking candidates who:** + **Hold an active… more
- US Tech Solutions (Columbia, SC)
- …or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and ... for Federal Employees **Responsibilities:** + Performs medical reviews using clinical /medical information provided by physicians/providers and established criteria/protocol sets… more
- US Tech Solutions (Columbia, SC)
- …benefits or services, and appeals. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and ... + 80% May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a… more
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