- AmeriHealth Caritas (LA)
- …and providers to collect all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer 's discretion to retain ... direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical necessity reviews. Using clinical… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- Abbott (Maple Grove, MN)
- …diabetes from routine fingersticks. **The Opportunity** We are looking for our next **Manager, Clinical Data Review ** to lead our team on-site out of our Maple ... execute processes; continually evaluate their effectiveness and appropriateness. The Manager, Clinical Data Review will exercise judgment in planning, organizing… more
- HCA Healthcare (Plano, TX)
- **Description** **Introduction** Do you have the career opportunities as a Clinical Denial Coding Review Specialist you want with your current employer? We have ... caring group of colleagues. Do you want to work as a Clinical Denial Coding Review Specialist where your passion for creating positive patient interactions is… more
- State of Georgia (Fulton County, GA)
- …Clinical Evaluator- Part Time- Sexual Offender Risk Review Board- Atlanta Georgia - Fulton - Atlanta ... Sign Up for Job Alerts Job Description Job Title: Clinical Evaluator- Part Time- Sexual Offender Risk Review Board- Atlanta Pay Grade: TPW Job Summary: Title … more
- State of Georgia (Fulton County, GA)
- Clinical Evaluator- Sexual Offender Risk Review ... Clinical Evaluator- Sexual Offender Risk Review Board- Atlanta Georgia - Fulton - Atlanta ... Job Sign Up for Job Alerts Job Description Job Title: Clinical Evaluator- Sexual Offender Risk Review Board- Atlanta Pay Grade: K Job Summary: Title Clinical… more
- Centene Corporation (Phoenix, AZ)
- …benefits including a fresh perspective on workplace flexibility. Centene is seeking a ** Clinical Review Nurse** to join our **Arizona Medicaid team** in 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
- CVS Health (Oklahoma City, OK)
- …**_Work at home Position-Must Reside in Oklahoma_** **Position Summary: Behavioral Health Clinical Reviewer (LCSW, LCPC, RN)** Licensed clinical professional ... health and a strong background in psychiatric care. As a Behavioral **Health Clinical Reviewer ** , your expertise will drive impactful decisions that improve… more
- Centene Corporation (New York, NY)
- …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, ... and cost effectiveness of medical care. + Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in… more