- The Cigna Group (Bloomfield, CT)
- …Analytics Sr. Manager oversees a team of analytics professionals focused on clinical quality measurement and insights. Works in collaboration with business ... development and maintenance of dashboards and reporting for stakeholders to monitor clinical quality results. **Position Summary:** This role leads strategic and… more
- The Cigna Group (Bloomfield, CT)
- **Job Overview:** This role is responsible for driving the Clinical Quality data acquisition strategy and data product support within the Enterprise Quality ... & Accreditation organization. The data being acquired will be used to measure clinical quality results that ultimately allow Cigna to benchmark against… 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 ... for our patients. The position will also participate in Process and Quality improvement in our developing area of Delegated Utilization Management. **ESSENTIAL JOB… 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 ... a case for determination, interacting directly with providers to obtain additional clinical information, and with members or their advocates to understand the full… more
- AmeriHealth Caritas (Lafayette, LA)
- …clinical criteria. Using professional judgment, the Utilization Management Reviewer assesses the appropriateness of services, identifies care coordination ... When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas of BCBSMA. The ... your true colors to blue. The Role The Physician Reviewer is responsible for evaluating clinical service...anticipatory case management for members whose cases come for review , in partnership with case managers + Participate in… more
- AmeriHealth Caritas (Washington, DC)
- …determinations based on clinical criteria. Using professional judgment, the Clinical Care Reviewer assesses the appropriateness of services, identifies care ... When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …gather clinical information to support the plan of care. + Monitor clinical quality concerns, make referrals appropriately, identify and escalate quality ... use of the member's benefit to provide the best quality care. The TeamThe RN Utilization Management Reviewer...with emphasis on utilization management, discharge planning, care coordination, clinical outcomes, and quality of service. +… more
- Adecco US, Inc. (Minneapolis, MN)
- …inpatient hospital setting . Experience applying benefits and criteria to clinical reviews . Utilization Management, pre-authorization, concurrent review , or ... Adecco Healthcare & Life Sciences is hiring remote RN Appeals Reviewers! This role is ...to $42.50 an hour **Responsibilities of the RN Appeals Reviewer :** . Responsible for conducting thorough reviews of member… more
- Centene Corporation (Concord, NH)
- …Nevada, Ohio, Illinois, New Hampshire.** **Join Centene's mission-driven team as a Remote Psychologist Reviewer specializing in Applied Behavior Analysis (ABA) ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
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