• PS Medical Review Coordinator

    University of Utah (Salt Lake City, UT)
    …**Requisition Number** PRN42418B **Job Title** PS Program Assistant **Working Title** PS Medical Review Coordinator **Job Grade** C **FLSA Code** Nonexempt ... us and help give the gift of sight! The Medical Review Coordinator at the Utah Lions...for transplantation. This role involves completing donor charts, reviewing medical records , and applying knowledge of … more
    University of Utah (08/07/25)
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  • Medical Review Coordinator II - Rral

    Prime Healthcare (Gadsden, AL)
    …Responsibilities Coordinates and completes the clinical reviews for all patient medical records while working closely with CMO (Chief ... being met; gathering data and responding to request for records from payers/fiscal intermediary etc.; gathering clinical and fiscal...or Nursing Graduate required. 2. Three years of Utilization Review experience as a Medical Review more
    Prime Healthcare (08/28/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Warren, MI)
    …state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure ... Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing...denial and modification of payment decisions + Independently re-evaluates medical claims and associated records by applying… more
    Molina Healthcare (09/06/25)
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  • Senior Manager, US Medical Information…

    Takeda Pharmaceuticals (Lexington, MA)
    …matter expert representative at Regional Medical Strategy Team meetings. + Medical review of other materials pertinent to Takeda business as required, ... the role:** Join Takeda as a Senior Manager, US Medical Information and Review where you will...both pre- and post-marketing research studies. * Proven track record of teamwork, leadership, timely decision making and results… more
    Takeda Pharmaceuticals (08/15/25)
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  • Utilization Review Medical Director

    Commonwealth Care Alliance (Boston, MA)
    …to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for providing ... **Essential Duties & Responsibilities:** + Primary responsibility for performing daily medical reviews, appeals as appropriate, correspondence regarding review more
    Commonwealth Care Alliance (09/05/25)
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  • Post Review Nurse - Utilization Management

    Actalent (Des Moines, IA)
    …reviews and claims assessments using InterQual criteria and medical policy. + Review medical records for suspended claims and provider inquiries to ... claims assessments. This role involves applying InterQual criteria and medical policy to evaluate medical records...+ Apply clinical criteria and benefit information to support medical review decisions. + Ensure compliance with… more
    Actalent (09/05/25)
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  • Medical Consultant Review

    ABBTECH Professional Resources, Inc. (Reston, VA)
    …an accident, as well as future pain and suffering/treatment needed. The individual's medical records include crush injuries; a coma; TBI; crushed vocal chords; ... 1 year of experience in providing professional expertise to DoD preferred. * Medical Expert in orthopedic rehabilitation with vocal cord atrophy as secondary skill.… more
    ABBTECH Professional Resources, Inc. (08/23/25)
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  • Utilization Review Nurse - Case Management…

    Houston Methodist (The Woodlands, TX)
    …is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and level of ... or concurrently determines the appropriateness of inpatient or observation services following review of relevant medical documentation, medical guidelines,… more
    Houston Methodist (07/12/25)
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  • Manager, Utilization Review

    Children's Mercy Kansas City (Kansas City, MO)
    …management of patients, including patient statusing processes, ongoing monitoring of medical necessity review functions utilizing InterQual and/or MCG screening ... quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome focused family… more
    Children's Mercy Kansas City (06/17/25)
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  • RN Registered Nurse Patient Safety/Peer…

    Penn State Health (Reading, PA)
    …to support medical staff clinical quality professional practice evaluation. Perform review of medical records based on established definitions for ... to improve reliability of systems. Accountable for medical staff peer review coordination...including mortality review , and support the peer review process established in the medical staff… more
    Penn State Health (09/06/25)
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