- 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 (Atlanta, GA)
- …practice that is relevant to the clinical area(s) addressed in the initial clinical review . Pay Range: $26.50 - $47.59 per hour Centene offers a ... 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,… more
- Centene Corporation (Helena, MT)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Perform clinical /coding medical claim review to ensure compliance with coding ... changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene...practices through a comprehensive review and analysis of medical claims, medical records, claims… more
- Kelly Services (Fargo, ND)
- …(PA) seeking meaningful work that fits seamlessly into your current clinical schedule? Join Kelly Government Solutions, helping Veterans by conducting one-time ... 1-5 days per week, Monday-Saturday, 8:00am-7:00pm. Fill gaps in your clinical schedule. **Supplemental Income, No Odd Hours:** + Earn competitive per-exam… more
- Atlantic Health System (NJ)
- 1. Provides timely review of SOC, ROC and Recertification documentation. Utilizes CRC assessment tool to provide clinical feedback related to OASIS accuracy and ... chart based on primary and secondary reasons for home care through thorough chart review . Reviews and advances 485 in a timely manner. 3. Demonstrates proficient use… more
- US Tech Solutions (Columbia, SC)
- …or services, and appeals. + Documents decisions using indicated protocol sets or clinical guidelines. + Provides support and review of medical claims and ... + May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes… more
- US Tech Solutions (May, OK)
- **Summary:** Participates in the member and provider outreach, collection, and review of medical records to abstract clinical information for HEDIS quality ... (SDoH) barriers and provide helpful resources * Outreach to members and clinical providers to effectively coordinate care, obtain medical records and ensure patients… more
- Kelly Services (Pensacola, FL)
- …NP or PA** seeking meaningful work that fits seamlessly into your current clinical schedule? Help veterans secure the benefits they've earned, while expanding your ... documentation uploaded through a simple digital platform. Focus on your clinical expertise, not paperwork. **Meaningful Community Impact:** + Conduct Disability… more
- Zelis (NJ)
- …records utilizing ICD-10 Official Coding Guidelines, AHA Coding Clinic evidence based clinical criteria and client specific coverage policies. What you'll do: + ... billed, based on industry standard coding guidelines and the clinical evidence supplied by the provider in the form...Strong understanding of hospital coding and billing rules + Clinical and critical thinking skills to evaluate appropriate coding… more