- AmeriHealth Caritas (Washington, DC)
- …When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines ... **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient… more
- Cook Medical (West Lafayette, IN)
- …and Qualified candidates must be legally authorized to be employed in the United States . Cook does not intend to provide sponsorship for employment ... Posting Date3 months ago(7/14/2025 2:38 PM) Job Location(s)West Lafayette IN United States Job LocationsUS-IN-West Lafayette TravelLess than 10% Position… more
- Independent Health (Buffalo, NY)
- …The Clinical Reviewer will be responsible for the collection and review of medical records specific to quality complaints/grievances and appeals as indicated in ... a high performing health plan and physician network. The Clinical Reviewer will investigate quality complaints/grievances and appeals, document research of initial… more
- Zelis (FL)
- …Zelis, we Get Stuff Done. So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare ... interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay… more
- US Tech Solutions (Columbia, SC)
- …licensure in state hired, OR, active compact multistate RN license as defined by the Nurse Licensure Compact (NLC) **About US Tech Solutions:** US Tech ... decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. + Performs medical claim… more
- Virtua Health (Marlton, NJ)
- …Employee Employment Classification: Regular Time Type: Part time Work Shift: 1st Shift ( United States of America) Total Weekly Hours: 32 Additional Locations: ... over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques… more
- Kelly Services (Fargo, ND)
- …team: Proudly Serving Those Who Served** Are you a licensed MD, DO, Nurse Practitioner* (NP), or Physician Assistant* (PA) seeking meaningful work that fits ... locations where autonomous practice is permitted by state law. **Why Providers Join Us ** **Truly Flexible Scheduling:** + Set your own dial-choose 1-5 days per week,… more
- Zelis (NJ)
- …Zelis, we Get Stuff Done. So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare ... Zelis standards regarding privacy What you'll bring to Zelis: + Registered Nurse licensure preferred + Inpatient Coding Certification required (ie, CCS, CIC, RHIA,… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE ... regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team....to all rights afforded by the Constitution of the United States . The Department of Human Resources… more
- Cordis (Miami Lakes, FL)
- …activities related to product safety surveillance and risk management, including review of data from clinical studies, literature reviews, complaints, regulatory ... included in the reports to competent authorities around the world + Review of technical investigations and completeness of conclusions for returned product analysis… more
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