- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …adjudicate these requests. At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical ... Bring your true colors to blue. The Role The Physician Reviewer is responsible for evaluating clinical..., in partnership with case managers + Participate in Physician Psychologist Review Units' appeal process of… more
- ChenMed (Miami, FL)
- …The Physician Reviewer is the primary physician reviewer for Utilization Management/Clinical Appropriateness review cases in our organization. Other ... duties include advising other physician reviewers and attending daily calls with health plan...preferred + At least one (1) year of utilization review experience preferred **PAY RANGE:** $198,797 - $283,995 Salary… more
- Sharp HealthCare (San Diego, CA)
- …direction of Authorization Review for Sharp Health Plan (SHP). The Physician Reviewer will perform all reasonably necessary functions to ensure quality ... + 5 years' experience as a practicing primary care physician with knowledge of managed care and the process...of managed care and the process for prior authorization review . + California Physicians and Surgeons License - Medical… more
- Chenega Corporation (Rockville, MD)
- …a **Chenega Professional Services Strategic Business Unit** company, is looking for a Physician - Contract Medical Reviewer (CMR) to support the Department of ... or License to practice in the US as a physician 's assistant or nurse practitioner. + Licensure: Must possess...MD location. + Professional Background: Relevant experience in claims review , healthcare administration, or related fields. + A minimum… more
- Kelly Services (Raleigh, NC)
- …community and earn extra income? Join Kelly Government Solutions as a Physician Disability Reviewer , performing one-time Disability Evaluations (DBQs) for ... **Become a Physician Disability Evaluator for Veterans - Raleigh, North...VA benefits purposes._ **Who We're Looking For** + **Licensed Physician ** (MD or DO only) + **Active, unrestricted US… more
- Evolent (Olympia, WA)
- …Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/ Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support and assistance for ... with the Director of UM to ensure client satisfaction. Perform all peer clinical review activities while located in a state or territory of the United States. Acts… more
- Kelly Services (Pensacola, FL)
- …Government Solutions team: Proudly Serving Those Who Served** Are you a licensed ** Physician ** (MD or DO), or **autonomous NP or PA** seeking meaningful work that ... Role** + Perform one-time veteran disability evaluations (DBQs/C&P exams) + Review health histories, assess whether injuries/conditions are likely service-related +… more
- AmeriHealth Caritas (Lafayette, LA)
- …for approval or denial decisions. + Identify and escalate complex cases requiring physician review or additional intervention. + Ensure compliance with industry ... cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines to authorize… more
- AmeriHealth Caritas (Washington, DC)
- …for approval or denial decisions + Identify and escalate complex cases requiring physician review or additional intervention + Ensure compliance with Medicaid ... cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines to authorize… more
- Hartford HealthCare (Hartford, CT)
- …Island. We consist of a team of professionals ranging from Medical Assistants to Physician Assistants and everything in between. Our physician led medical group ... The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection, documentation,… more