- Evolent (Springfield, IL)
- … Reviewer . In States where allowed, will make denial determinations as a specific case warrants. + Converses with medical office staff in order to obtain ... providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and...the culture. **What You'll Be Doing:** As a Clinical Reviewer , Speech Therapy you will be a key member… more
- APTIM (Santa Fe, NM)
- **Summary:** The Senior-Level Claims Reviewer is responsible for independently reviewing, analyzing, and processing complex claims related to disaster losses in ... on claims interpretation, policy compliance, and documentation quality. The Senior Reviewer also supports mentoring of mid-level staff, provides guidance on… more
- Veterans Affairs, Veterans Health Administration (Martinsburg, WV)
- …well as customer service programs. Responsibilities The Risk Manager Clinical Reviewer (RMCR) Registered Nurse (RN) is responsible for providing competent, ... Performs clinical reviews for Occurrence Screens and/or Tort Claims and recommends Peer Review when quality of care issues are recognized. Prepares the Peer … more
- APTIM (Santa Fe, NM)
- **Summary:** The Mid-Level Claims Reviewer supports the claims process by reviewing, evaluating, and documenting claims for disaster-related losses. This role ... needed. **Key Responsibilities/Accountabilities:** + Ability to understand and interpret complex federal policy language, including relevant statutes, regulations, policies,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …conjunction with Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or ... appropriate cases to the Medical Director for review . Refer to and work closely with Case...in improving member and community health. + Manages more complex assignments; cross-trained to review various levels… more
- The Cigna Group (Bloomfield, CT)
- …is responsible for the following: + Laboratory molecular and genetic testing clinical case review activities. + Evaluate telephone, fax, or web requests for ... coverage of services or referring requests for expert clinical review as appropriate. + Be available as an expert...Strong interpersonal skills with the ability to clearly explain complex medical information in both verbal and… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …characteristic. Blue Cross and Blue Shield of Minnesota Position Title: RN Specialist Complex Case Manager - Oncology Location: Remote Career Area: Health ... * Receives referral for member identified with high cost, complex medical conditions and telephonically outreaches to...to the member, family and providers to engage in complex case management program. * Conducts clinical… more
- Henry Ford Health System (Detroit, MI)
- …with computers, electronic health records (EHR), database systems, and utilization review / case management documentation systems. + Knowledge of CMS, commercial ... sign on bonus available for qualified experienced candidates with current 2 years RN Case Management in a large acute care hospital setting. GENERAL SUMMARY: The … more
- Henry Ford Health System (Detroit, MI)
- …of computers, Electronic Health Records, data base systems and utilization review / case management documentation systems. Desire to work collaboratively and ... for qualified experienced candidates with current 2 years MSW Case Management in a large acute care hospital setting....of services - from primary and preventative care to complex and specialty care, health insurance, a full suite… more
- Price Benowitz LLP (Washington, DC)
- …team. Job Summary Price Benowitz, LLP is looking to add a full-time Personal Injury Medical Case Manager to join its growing team at its Washington, DC ... headquarters. You will coordinate medical case management efforts across our department,...and support to legal team members as needed. + Review and analyze clients' medical records and… more