- Centene Corporation (Sacramento, CA)
- …referrals in accordance with policies and guidelines + Supports the authorization review process by researching and documenting necessary medical information ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- The Cigna Group (Bloomfield, CT)
- …processes for Continuous Quality Improvement (CQI). Key Job Functions: * Conduct medical records reviews with accurate diagnosis code abstraction in accordance ... The Risk Adjustment Quality & Review Analyst in IFP brings medical coding and Hierarchical Condition Category expertise to the role, evaluates complex medical… more
- US Bank (Cincinnati, OH)
- …you excel at-all from Day One. **Job Description** Job Summary: The Credit Review Specialist is responsible for evaluating credit decisions for new credit card ... updates to credit card applications and account information. Key Responsibilities: - Review and assess new credit card applications to determine creditworthiness.… more
- Sedgwick (San Francisco, CA)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Senior Estimate Review Specialist **PRIMARY PURPOSE** **:** To review all estimates and ... reviews, and sends fair and accurate estimates through various platforms. + Records data around initial estimates reviewed, number of reviews, and rejections on… more
- Sanford Health (Bismarck, ND)
- …in the right setting while supporting quality outcomes and hospital success. What You'll Do: Review records for medical necessity & level of care Collaborate ... Your RN Skills in a New Way RN Utilization Review Nurse Bring your clinical expertise beyond the bedside!...City. Required in Fargo and Sioux Falls (Sanford USD Medical Center and Clinics). Required in Bismarck or enrolled… more
- CDPHP (Latham, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for ... authorization. This includes approval determinations and appropriate exceptions, coordinating with Medical Directors on denials. In addition, the UR nurse is… more
- Harris & Associates (Irvine, CA)
- …Senior Project Manager to help lead, market and expand our Cost Reimbursement Review team. The ideal candidate will have strong project management skills, experience ... project schedules, and monitoring project budgets. + Leads cost reimbursement review projects including change order reviews, preparation of cost estimates, and… more
- Centene Corporation (Sacramento, CA)
- …Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity ... 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- Citigroup (Wilmington, DE)
- **Job Description: Senior Validator - AI Non-Model Risk Review Team (Hybrid)** The Risk Analytics, Modeling, and Validation role focuses on developing, enhancing, ... market, credit, and operational risks. The AI Non-Model Risk Review team within Model Risk Management is seeking a...Experience mentoring or coaching team members, with a track record of fostering growth and development in others. +… more
- Fluor (Reston, VA)
- …assessments regarding proposal readiness for color team reviews; set color team review goals and objectives; deconflict color team reviewer feedback; in ... is a leading government contractor with a proven track record of delivering high‑value technical solutions around the world...with the Capture Manager, determine disposition of color team reviewer comments and develop the color team recovery plan… more