- St. George Tanaq Corporation (Phoenix, AZ)
- …US Eastern, Central or Mountain Time Zones. **Responsibilities** + Reviews medical records /case file, writes a reconsideration/dispute resolution decision that ... Dispute Resolution Reviewer III Fully Remote*GA Job Type Full-time Description...of medical dispute resolution or Medicare appeals, medical review , clinical, or related experience in… more
- Volunteers of America Los Angeles (Los Angeles, CA)
- …PURPOSE Under the direction of a Quality Assurance Coordinator, the Quality Assurance Reviewer II performs Quality Assurance review and audit of VOALA Program ... Quality Assurance Reviewer II Location:Los Angeles, CA Job ID:3903 Salary:$29.18...PAY RATE:$29.18 - $30.72 Per Hour BENEFITS:VOALA offers competitive medical , dental, vision and retirement benefits. JOB SUMMARY AND… more
- Conduent (Alexandria, VA)
- …individuality is noticed and valued every day. **Pharmacist - Claims Auditor/ Reviewer (Part-Time)** **Conduent Payment Integrity Solutions** **Are you a licensed ... audits on behalf of major healthcare payers. As a **Pharmacist - Claims Auditor/ Reviewer ** , you'll apply your clinical knowledge and regulatory expertise to assess… more
- Guthrie (Troy, PA)
- …benefit plans and related UM requirements preferred. Experience with CPT/ICD coding, medical record or chart auditing, and experience in utilization management ... a $15,000.00 Sign on Bonus! Summary The LPN Utilization Management (UM) Reviewer , in collaboration with Care Coordination, Guthrie Clinic offices, other physician… more
- Zelis (St. Petersburg, FL)
- …of hospital coding and billing rules + Clinical skills to evaluate appropriate Medical Record Coding + Experience performing regulatory research from multiple ... review content, including but not limited to DRG Reviewer Rationales, DRG Clinical Validation Policies, CCR Review...provider disputes. + Utilize the most up-to-date approved Zelis medical coding sources for bill review maintenance.… more
- Aston Carter (Lombard, IL)
- …a commitment to process accuracy and efficiency. Key Responsibilities: + Monitor, review , and process violation records in accordance with established procedures ... Job Summary: The Violation Reviewer is responsible for guiding and supporting a...of Violation Reviewers. This role involves assisting the Violation Review Supervisors, processing supervisor-level approvals, and performing the core… more
- CVS Health (Columbus, OH)
- …all with heart, each and every day. **Position Summary** The Care Plan Reviewer (Clinical Case Manager BH) utilizes advanced clinical judgment and critical thinking ... Members: + Through the use of clinical tools and information/data review , conducts comprehensive assessments of referred member's needs/eligibility and determines… more
- Amentum (Hawthorne, NV)
- **Amentum** is seeking an **Installation Status Reviewer ** to join our team in **Hawthorne, Nevada** to support the Hawthorne Army Depot. The **Installation Status ... Review ** will be a key staff member of the...at work when scheduled and maintain a good attendance record . + Work near and or in an ammunition/explosive's… more
- Centene Corporation (Indianapolis, IN)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... license in Indiana.** **Join Centene's mission-driven team as a Remote Psychologist Reviewer specializing in Applied Behavior Analysis (ABA) with a focus on… more
- Centene Corporation (Trenton, NJ)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... or New Jersey** . **Join Centene's mission-driven team as a Remote Psychologist Reviewer specializing in Applied Behavior Analysis (ABA) with a focus on individuals… more