- Elevance Health (San Juan, PR)
- …providing information technology and business operations services for health plans._ ** Nurse Reviewer I** **Location:** This role requires associates to ... but must be flexible according to business needs. The ** Nurse Reviewer I** is responsible for conducting...current unrestricted RN license from one of the 50 states of the United States … more
- Elevance Health (Walnut Creek, CA)
- ** Nurse Reviewer I** Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... if necessary. New Grads are encouraged to apply! The ** Nurse Reviewer I** will be responsible for...that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or… more
- Idaho Division of Human Resources (Boise, ID)
- BLTC Nurse Reviewer - MED Posting Begin Date: 2025/07/31 Posting End Date: 2025/08/14 Category: Nursing Work Type: Full Time Remote: Flexible Hybrid Location: ... Boise, ID, United States Minimum Salary: 33.61 Maximum Salary:...your community while utilizing your experience as a Registered Nurse ? The Idaho Department of Health and Welfare is… more
- Trinity Health (Livonia, MI)
- …one in there says HMS and needs to state MSQC. Posting Posting The Clinical Nurse Reviewer 's chief responsibility is to collect and submit reliable data on ... of all eligible cases for the hospital. The Clinical Nurse Reviewer also works closely with the...colleagues and nearly 26,000 physicians and clinicians across 25 states . Because we serve diverse populations, our colleagues are… 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 Date4 weeks 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
- Zelis (St. Petersburg, FL)
- …maintain bill review content, including but not limited to DRG Reviewer Rationales, DRG Clinical Validation Policies, CCR Review Guidelines and Templates, ... Done. So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across...disputes as they relate to DRG validation, itemized bill review , and/or clinical claim review Expert Claim… more
- Kelly Services (Plainsboro, NJ)
- **Pharmacovigilance QC Reviewer II** Location: Plainsboro, NJ Schedule: Hybrid role with at least 3 days/week onsite is expected Length 1 year Pay: 28:00 **Job ... Bachelor's degree, HCP degree is required eg, pharmacist or nurse ; advanced degree preferred * Experience Level: 3+ Years...promise to talent, Kelly supports those who work with us through a variety of benefits, perks, and work-related… more
- AmeriHealth Caritas (LA)
- …When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines ... **Responsibilities:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and… 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
- 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