- Dignity Health (Rancho Cordova, CA)
- …from home** **within driving distance of Sacramento, CA** **.** As a Utilization Review (UR) LVN, you will use clinical judgement in providing utilization management ... high quality, cost-effective care which will enable patients to achieve maximum medical improvement while receiving care deemed medically necessary. You will assist… more
- RTX Corporation (Midland, GA)
- …as only US citizens are authorized to access information under this program/ contract . **Security Clearance:** None/Not Required Pratt & Whitney is working to once ... Will Do** We have an opportunity for a Material Review Board Team Member to be based in Columbus,...US citizens are authorized to access information under this program/ contract . **Qualifications We Prefer** + Skilled in processing of… more
- MyFlorida (Tallahassee, FL)
- OPERATIONS REVIEW SPECIALIST - LW - 60060348 1 Date: Oct 31, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... . Requisition No: 864324 Agency: Children and Families Working Title: OPERATIONS REVIEW SPECIALIST - LW - 60060348 1 Pay Plan: Career Service Position… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …language specifically symptom\-driven, treatment driven, look back periods, rider information and medical policy/ medical review criteria **Number of Openings ... **Join our team as a Clinical Review Manager\!** We are seeking a quick learner...review requests, and UM pre\-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility\. +… more
- Point32Health (Canton, MA)
- …prepayment investigations, involving internal and external research, detailed data analysis, review of medical records, and interviews of members, providers, ... schemes. + Handling substantial prepayment claims including extensive administrative tasks, review of medical records, and communicating with providers through… more
- Amentum (Washington, DC)
- …variety of computer applications, including word processing, databases (such as document review and file management systems), spreadsheets, and imaging. + Role also ... of eDiscovery procedures and resources. + Experienced with document review in Relativity This is a remote position that...by the Department of Labor (DOL) as a Service Contract Act (SCA) contract . The DOL regulates… more
- HonorHealth (AZ)
- …high quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, ... payers and others to appeal individual denials and trended issues related to contract guidelines. Works with medical records, finance and physician groups to… more
- Molina Healthcare (Long Beach, CA)
- …JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... * Processes requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents cases in a consistent and efficient manner.… more
- RTX Corporation (Midland, GA)
- …as only US citizens are authorized to access information under this program/ contract . **Security Clearance:** None/Not Required Pratt & Whitney is working to once ... shift work and ability to work overtime when needed. The Quality Review Clerk/Attendant performs a variety of manual/administrative tasks associated with inventory… more
- Cambrex High Point (Charles City, IA)
- Company Information You Matter to Cambrex. Cambrex is a leading global contract development and manufacturing organization (CDMO) that provides drug substance, drug ... a career where You Matter by applying today! Job Overview The Data Review Scientist will be responsible for reviewing laboratory data and supporting documentation to… more