- Optum (San Juan, PR)
- …production environment. Primary Responsibilities: Clinical Case Reviews -75% Perform clinical review of professional (or facility) claims vs. medical records ... and accuracy. Standards are defined by the department Provide clear and concise clinical logic to the providers when necessary Examine, assess, and document business… more
- Christian Care Ministry (Orlando, FL)
- …God and our Members to the best of our ability. The Job The Senior Clinical Reviewer works to summarize and correlate concise, accurate information on medical ... required 1-3 years' experience in medical reviews required 2-3 years of clinical experience strongly preferred Experience with Utilization Review or Case… more
- Elevance Health (Cerritos, CA)
- …Position Title: Therapy Services Reviewer Job Description: The Therapy Services Reviewer is responsible for the review of medical records to determine ... regulations and requirements. *Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary. *Acts as a resource… more
- BRISTOL HOSPITAL GROUP (Bristol, CT)
- …Level 4 Year Degree Job Shift 1st Shift (Days) Description Registered Nurse Utilization Reviewer At Bristol Health, we begin each day caring today for your tomorrow. ... your choice. Job Summary: The Utilization Management (UM) department reviews clinical documentation for medical necessity criteria, guided treatment plans, and… more
- TurningPoint Healthcare Solutions, LLC (Lake Mary, FL)
- …which were not approved by pre- review screening process or by the initial Clinical Reviewer 's algorithm. Review of pended cases to obtain all necessary ... Medical Director/ Physician Reviewer - Spine Who We Are: TurningPoint Healthcare Solutions...Are: TurningPoint Healthcare Solutions is a leader in advanced clinical and technology-enabled complex condition management. TurningPoint provides an… more
- US Tech Solutions (Canton, MA)
- …This is Fully remote, but Massachusetts RN license required. Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that ... a clinically complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical necessity and,… more
- Telligen (West Des Moines, IA)
- This position provides front line intake clinical screening to members who need skilled nurse assessment services. The incumbent is accountable for performing and ... in the community or in facilities. Assessor Reviewers also may complete review decisions regarding services needed to be successful in the community. Essential… more
- Merck & Co. (Rahway, NJ)
- …on the clinical trial team. Leading medical monitoring team in review and interpretation -of clinical data/medical protocol deviations in collaborations with ... scientific -pl anning and execution of one or more clinical trials or significant aspects thereof . In this...Job Responsibilities - Responsible for leading specific aspects of clinical /scientific execution of clinical protocol(s) . This… more
- Merck & Co. (Rahway, NJ)
- …chain deliverables and prepares , analyses , and/or develops mitigation strategies for review with clinical partners and senior leaders.- - Works directly in ... Job DescriptionThe Global Clinical Supply (GCS) organization is accountable for managing...(GCS) organization is accountable for managing the 'end-to-end' integrated clinical supply chain across the full c ompany's Research… more
- Merck & Co. (Rahway, NJ)
- …supply chain deliverables and prepares, analyzes, and/or develops mitigation strategies for review with clinical partners and senior leaders. -Responsible and ... Job DescriptionThe Global Clinical Supply (GCS) organization is accountable for managing...(GCS) organization is accountable for managing the 'end-to-end' integrated clinical supply chain across the full Research & Development… more
