- The Hartford (Hartford, CT)
- …Review / Utilization Review for Workers' Compensation Claims. An Initial Clinical Reviewer (ICR) is responsible for evaluating treatment requests in ... The Clinical team is seeking an Initial Clinical Reviewer . In this position, the individual...using nursing judgment, treatment criteria guidelines and Physician Advisor/Peer Clinical Review referral process. Conduct first level… more
- AdventHealth (Orlando, FL)
- …Shift **The role you'll contribute:** Under general supervision of the Director of Clinical Documentation Integrity and in some situations the supervision of the ... Clinical Documentation Integrity Manager, and in collaboration with physicians,...with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality… more
- 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
- Independent Health (Buffalo, NY)
- …benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Clinical Reviewer will be responsible for the collection and review ... support of a high performing health plan and physician network. The Clinical Reviewer will investigate quality complaints/grievances and appeals, document… more
- 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
- 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
- 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
- Robert Half Accountemps (Ontario, CA)
- Description We are looking for a detail-oriented Clinical Appeals Reviewer to join our team in Ontario, California. In this role, you will be responsible for ... coordinating and managing documentation related to clinical appeals, ensuring compliance with health plan timelines. This...with provider offices and other entities. * Knowledge of clinical trial operations or related healthcare processes is a… more
- AmeriHealth Caritas (Washington, DC)
- …SIGN ON BONUS** **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for ... on clinical criteria. Using professional judgment, the Clinical Care Reviewer assesses the appropriateness of...cases are escalated to the Medical Director for further review . The reviewer independently applies medical and… more
- University of Colorado (Aurora, CO)
- **Quality Control Analyst I Data Reviewer /Technical Writer** **Description** **University of Colorado Anschutz Medical Campus** **Department: Gates Biomanufacturing ... Facility** **Job Title: Quality Control Analyst I - Data Reviewer /Technical Writer** **Position #: 803791 - Requisition #:37813** **Job Summary:** Key… more
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