- Independent Health (Buffalo, NY)
- …The Clinical Reviewer will be responsible for the collection and review of medical records specific to quality complaints/grievances and appeals as indicated in ... a high performing health plan and physician network. The Clinical Reviewer will investigate quality complaints/grievances and appeals, document research of initial… more
- St. Luke's University Health Network (Bethlehem, PA)
- …regardless of a patient's ability to pay for health care. The Admission's Clinical Reviewer is responsible for the comprehensive medical review and screening of ... and responds to all inquiries for admission to ARC + Completes thorough review of documentation and information and assesses a patient's appropriateness for ARC… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- Cook Medical (West Lafayette, IN)
- …is currently accepting applications for a Scientific Communications Medical Reviewer to join our growing Scientific Communications/Clinical team. Medical Reviewers ... provide medical review of documents written by team members who do...MD or DO with medical device experience preferred; however, nurse practitioners and physician assistants may qualify, depending on… more
- Zelis (FL)
- …interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay ... AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest savings for… more
- Nuvance Health (Poughkeepsie, NY)
- …Must be available during weekday hours. 8a-5p *Purpose: *The Quality Systems Reviewer assists in the implementation of the Agencyi? 1/2s Performance Improvement, ... program dashboard on quality and process measures.Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as appropriate.… more
- Magellan Health Services (Somerset, PA)
- …skills and demonstrated experience. General Job Information Title Quality Clinical Reviewer - Somerset-Bedford, PA Grade 25 Work Experience - Required Clinical ... MgmtCare Mgmt, PSY - Psychologist - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care MgmtCare Mgmt License and Certifications… more
- Kelly Services (Fargo, ND)
- …team: Proudly Serving Those Who Served** Are you a licensed MD, DO, Nurse Practitioner* (NP), or Physician Assistant* (PA) seeking meaningful work that fits ... Role** + Perform one-time veteran disability evaluations (DBQs/C&P exams) + Review health histories, assess whether injuries/conditions are likely service-related +… more
- US Tech Solutions (Columbia, SC)
- …decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. + Performs medical claim ... in state hired, OR, active compact multistate RN license as defined by the Nurse Licensure Compact (NLC) **About US Tech Solutions:** US Tech Solutions is a global… more
- Zelis (NJ)
- …Zelis standards regarding privacy What you'll bring to Zelis: + Registered Nurse licensure preferred + Inpatient Coding Certification required (ie, CCS, CIC, RHIA, ... RHIT) + 5+ years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims preferred + Solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers + Experience and working knowledge of Health… more