- City of New York (New York, NY)
- …is recruiting for (1) one Principal Administrative Associate, who will function as a Senior Case Reviewer : - Conduct legally mandated case reviews to comply ... with all statutory, regulatory, and contractual standards. The Process Evaluation Review Team (PERT) is tasked with aggressively monitoring program compliance with… more
- EGA Associates (Washington, DC)
- …Health and Information Management **Specialty** Auditor **Job ID** 17470364 **Job Title** Medical Case Reviewer **Shift Details** **Shift** 08:00 AM - 04:30 PM ... **Shifts Per Week** 5 **scheduledHrs_1** 40.0 **Job Order Details** **Start Date** 2025-08-25 **End Date** 2026-08-24 **Duration** 52 Week(s) **Float Required** No **Call Required** No **Client Details** **City** Washington **State** DC EGA Associates, LLC… more
- Guthrie (Cortland, NY)
- Summary The LPN Utilization Management (UM) Reviewer , in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, and the Robert Packer ... collaborative relationships with members of the healthcare team. + Proactively researches case findings related to payer audits of UM decisions and prepares input… more
- Healthfirst (NY)
- **Duties//Responsibilities:** + The Medical Peer Reviewer will assess// review requests for authorization, and claims payment, based on medical records and ... and make informed clinical judgments and recommendations. + The Medical Peer Reviewer will render determinations in the format and within timeframes to follow… more
- State of Colorado (Denver, CO)
- …services systems. Specifically, the ARD is the mechanism responsible for the federally required Case Review System and a portion of the Quality Assurance System ... mechanism responsible for: + Child Welfare Quality Assurance: + The federally required child welfare Case Review and Qualitative Case Review systems, +… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas ... your true colors to blue. The Role The Physician Reviewer is responsible for evaluating clinical service requests made...case management for members whose cases come for review , in partnership with case managers +… 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
- Commonwealth Care Alliance (Boston, MA)
- …to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical and service authorization ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS compliance standards in the… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview: ;** The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory ... obtaining and reviewing medical records, packaging pertinent information into a case for determination, interacting directly with providers to obtain additional… more
- APTIM (Santa Fe, NM)
- **Summary:** The Senior-Level Claims Reviewer is responsible for independently reviewing, analyzing, and processing complex claims related to disaster losses in ... on claims interpretation, policy compliance, and documentation quality. The Senior Reviewer also supports mentoring of mid-level staff, provides guidance on… more
Recent Jobs
-
Finance Transformation Integration Program Manager Consultant
- RGP (San Francisco, CA)
Related Job Searches:
Case,
Case Reviewer NP,
Complex Medical Case Reviewer,
EIS Case Reviewer,
NCA Pert Case Reviewer,
Physician Case Reviewer AIM,
Quality Control Case Reviewer,
Reviewer,
Senior Case Reviewer