• VitalCore Health Strategies (Hopkinton, MA)
    …* Utilization Management experience. * Must have minimum of 5 years clinical experience in Family Practice, Emergency Medicine, Internal Medicine, Public Health, or ... care in a region. * Serve as liaison for clinical matters related to on-site, off-site specialty care, emergency...and assistance to the on-site quality improvement program, including review of grievances and development of corrective action plans… more
    Get It 2025 (11/25/25)
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  • VitalCore Health Strategies (Smyrna, DE)
    …and paraprofessional staff. * Ensure and provide on-call services. * Annually review and approve clinical protocols, policies and procedures, and medical ... health authority required by national standards. They provide overall supervision for clinical services for the site to ensure appropriate delivery of on and… more
    Get It 2025 (11/25/25)
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  • VitalCore Health Strategies (Hopkinton, MA)
    …The Psychologist will performing clinically sound suicide risk evaluations, including clinical review , applying suicide risk assessment protocols, pertinent ... health assessments, provide therapy and counseling, administrative meetings, writing clinical reports regarding diagnoses, prognoses, and developing treatment plans… more
    Get It 2025 (11/25/25)
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  • ColumbiaCare Services (Eugene, OR)
    …performing housekeeping and meal preparation, administering medication, and keeping accurate clinical documentation. If you have experience working as a Qualified ... Bridge program serves 8 adults under the jurisdiction of the Psychiatric Security Review Board (PSRB), and another 8 adults that are under civil commitment.… more
    Get It 2025 (11/25/25)
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  • Clinical Nurse Reviewer Neonatal ICU

    HCA Healthcare (Austin, TX)
    …Manager using facility approved audit tools. As the NICU Clinical Nurse Reviewer , . You will review patient's medical record and documents' compliance of ... medical records to ensure the standard of care is provided. The RN Clinical Reviewer is responsible for the analysis of the medical accord and then documenting… more
    HCA Healthcare (11/15/25)
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  • Surgical Clinical Reviewer - General…

    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
    Hartford HealthCare (09/30/25)
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  • Admissions Clinical Reviewer

    St. Luke's University Health Network (Bethlehem, PA)
    …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 all ... 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
    St. Luke's University Health Network (11/06/25)
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  • UM Clinical Reviewer

    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
    Centers Plan for Healthy Living (10/14/25)
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  • Clinical Appeals Reviewer

    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 (10/13/25)
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  • Medical Peer Reviewer

    Healthfirst (NY)
    **Duties//Responsibilities:** + The Medical Peer Reviewer will assess// review requests for authorization, and claims payment, based on medical records and ... internal Healthfirst information and make informed clinical judgments and recommendations. + The Medical Peer ...clinical judgments and recommendations. + The Medical Peer Reviewer will render determinations in the format and within… more
    Healthfirst (11/13/25)
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