- State of Massachusetts (Westborough, MA)
- …at ### and select option #4. *Applicants should upload a_cover letter_and_resume_for the Nurse Reviewer requisition.* *First consideration will be given to those ... Services* **Organization:** **Exec Office Of Health and Human Services* **Title:** * Nurse Reviewer * **Location:** *Massachusetts-Westborough - 167 Lyman Street*… more
- Elevance Health (Houston, TX)
- ** Nurse Reviewer I** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... expanding set of clinical domains, including radiology, cardiology and oncology. The ** Nurse Reviewer I** is responsible for conducting preauthorization, out of… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day… more
- Elevance Health (Chicago, IL)
- **Appeals Nurse Reviewer I** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... clinical domains, including radiology, cardiology and oncology. The **Appeals Nurse Reviewer I** is responsible for conducting...Outreach to providers with appeal process instructions. + Clinical review for the RBM and Surgical solution on a… more
- City of New York (New York, NY)
- …health standards for children in foster care. The New Admissions Focused (NAF) Nurse Reviewer will be responsible for: 1. Scheduling and conducting NAF ... 5 boroughs 2. Participating in all post medical record review quality monitoring and corrective action processes 3. Conducting...subject of a child abuse and maltreatment report. STAFF NURSE - 50910 Qualifications 1. A valid New York… more
- 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
- AdventHealth (Orlando, FL)
- …collaboration with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality physician ... complexity of care of the patient. The Second Level Reviewer I educates members of the patient care team...(ROM), and quality. + Completes accurate and timely record review to ensure the integrity of documentation compliance. +… more
- Hartford HealthCare (Hartford, CT)
- …The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection, documentation, ... registry activities, including program teleconferences and meetings. Maintains Surgical Clinical Reviewer (SCR) certification on an annual basis, in accordance with… more
- State of Minnesota (St. Paul, MN)
- **Working Title: Case Mix Reviewer ** **Job Class: Nursing Evaluator** **Agency: Health Department** + **Job ID** : 89414 + **Location** : St. Paul + **Telework ... (MDH) + **Division/Unit** : Health Regulation / Case Mix Review + **Work Shift/Work Hours** : Day Shift /... (CMR) audit process. Working as a Case Mix Reviewer you will: + Evaluate and conduct audits on… 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