- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …therapists, and facilities as needed to gather clinical information to support the plan of care . + Monitor clinical quality concerns and make appropriate ... services within scope of practice per business needs. The reviewer will ensure services align with established clinical...sites of service to develop a cost-effective, medically necessary plan of care . + Successfully complete/pass the… more
- Commonwealth of Pennsylvania (PA)
- Clinical Care Reviewer (County Care Management Manager) (Local Government) - Fayette County MH/ID Print ... (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/4995788) Apply Clinical Care Reviewer (County ...WORK BEHAVIOR 3 - FACILITATES MEETINGS Facilitates behavioral health care management plan or treatment team meetings… more
- Centers Plan for Healthy Living (Margate, FL)
- …applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help ... home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all...of members' care /social needs, developing a "living care plan " that is modified as needed,… more
- BJC HealthCare (St. Louis, MO)
- …relevant work experience) **Additional Information About the Role** BJC is hiring for a Surgical/ Clinical Reviewer . This is a remote position. Must be located in ... medical schools in the country. **Preferred Qualifications** **Role Purpose** The Surgical Clinical Reviewer (SCR) is responsible for abstracting and sharing… more
- Commonwealth Care Alliance (Boston, MA)
- …the provisions of CCA's benefits plan . The Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical and service authorization ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for… more
- The Cigna Group (Bloomfield, CT)
- …clinical protocols; and authorizing coverage of services or referring requests for expert clinical review as appropriate. + Be available as an expert advisor ... Counselor is responsible for the following: + Laboratory molecular and genetic testing clinical case review activities. + Evaluate telephone, fax, or web… more
- Magellan Health Services (Honolulu, HI)
- …solutions that directly influence quality of care . General Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work Experience ... specific utilization problems, plan and implement...- Required CEAP - Certified Employee Assistance Professional - Care MgmtCare Mgmt, LCSW - Licensed Clinical … more
- HCA Healthcare (Brownsville, TX)
- …want to join an organization that invests in you as a Coding Quality Audit Reviewer ? At Parallon, you come first. HCA Healthcare has committed up to $300 million in ... and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. +...resources for emotional, physical and financial wellbeing + 401(k) Plan with a 100% match on 3% to 9%… more
- Elevance Health (Walnut Creek, CA)
- **Nurse Reviewer I** Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... work weekends if necessary. New Grads are encouraged to apply! The **Nurse Reviewer I** will be responsible for conducting preauthorization, out of network and… more
- ChenMed (Miami, FL)
- …to join our team. The Physician Reviewer is the primary physician reviewer for Utilization Management/ Clinical Appropriateness review cases in our ... your kindness and joy? We're different than most primary care providers. We're rapidly expanding and we need great...other physician reviewers and attending daily calls with health plan teams and our local teams assisting with this… more