- Hartford HealthCare (Hartford, CT)
- …different specialties. The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely ... data registry activities, including program teleconferences and meetings. Maintains Surgical Clinical Reviewer (SCR) certification on an annual basis, in… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- … Clinical Appeals Nurse Reviewer is responsible for applying sound clinical judgement to review provider and member appeals for denied services according ... TeamAs an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a liaison and business expert for member and provider… 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
- State of Georgia (Fulton County, GA)
- Certification Reviewer - Clinical Experience Preferred- Atlanta Georgia - Fulton - Atlanta ... this Job Sign Up for Job Alerts Job Description Job Title: Certification Reviewer - Clinical Experience Preferred- Atlanta Pay Grade: M Job Summary: Conducts… more
- Zelis (St. Petersburg, FL)
- …and maintain bill review content, including but not limited to DRG Reviewer Rationales, DRG Clinical Validation Policies, CCR Review Guidelines and ... of facility and provider disputes as they relate to DRG validation, itemized bill review , and/or clinical claim review Expert Claim Review . They will be… 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 ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- CVS Health (Columbus, OH)
- …do it all with heart, each and every day. **Position Summary** The Care Plan Reviewer ( Clinical Case Manager BH) utilizes advanced clinical judgment and ... across child-serving systems. Assessment of Members: + Through the use of clinical tools and information/data review , conducts comprehensive assessments of… more
- Evolent (Salem, OR)
- …clients as scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are performed… more
- Magellan Health Services (Somerset, PA)
- …Project management skills and demonstrated experience. General Job Information Title Quality Clinical Reviewer - Somerset-Bedford, PA Grade 25 Work Experience - ... need to reside in the PA area. Conducts reviews of clinical interactions and clinical documentation including reviews of case management records and provider… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The Clinical Pharmacist Reviewer reviews formulary exception, prior authorization and quantity ... Network and Medical Utilization Management for pharmaceuticals programs + Partner with clinical and non- clinical teams for staff training, facilitation of… more
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