- 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 We're ChenMed and we're transforming healthcare… 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
- Kelly Services (Melbourne, FL)
- …Solutions is seeking Healthcare Providers (Physicians - MD, DO or Physician Assistants PA** to conduct one-time disability exams for Veterans. **Location:** ... be an MD (Doctor of Medicine), DO (Doctor of Osteopathy), or PA ( Physician Assistant), and must be able to provide: Active/Unrestricted license Updated resume/CV… more
- Kelly Services (Milwaukee, WI)
- …+ **Perform one-time C&P Exams:** Focus on evaluation without ongoing treatment. + **Upload documentation:** Efficiently handle the paperwork. + **Direct payment:** ... **Join Kelly Government Solutions: Serve Those Who Served** Kelly Government Solutions, a trusted partner to the federal government, is actively seeking Physicians (MD, DO) to conduct Veteran Disability Evaluations (DBQs)in Milwaukee. We are committed to… more
- AdventHealth (Orlando, FL)
- …and in 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
- 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
- HCA Healthcare (Brownsville, TX)
- …want to join an organization that invests in you as a Coding Quality Audit Reviewer ? At Parallon, you come first. HCA Healthcare has committed up to $300 million in ... We are looking for a dedicated Coding Quality Audit Reviewer like you to be a part of our...result in appropriate reimbursement and data integrity. You will review outcomes are communicated to the HSC team to… 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
- Cook Medical (West Lafayette, IN)
- …is currently accepting applications for a Scientific Communications Medical Reviewer to join our growing Scientific Communications/Clinical team. Medical Reviewers ... provide medical review of documents written by team members who do...with medical device experience preferred; however, nurse practitioners and physician assistants may qualify, depending on training and experience;… more
- Zelis (St. Petersburg, FL)
- …interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay ... Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest...provider in the form of medical records such as physician notes, lab tests, images (x-rays etc.), and with… more
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