- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …providers, as appropriate. At the request of the Senior Medical Director of the Physician Review Unit (PRU), the reviewer also provides clinical leadership ... Bring your true colors to blue. The Role The Physician Reviewer is responsible for evaluating pre...anticipatory case management for members whose cases come for review , identifying opportunities for improved care coordination and placing… more
- Texas Health Action (Austin, TX)
- …records according to established standards + Maintains communication with the supervisory physician (s) and attending physician to review patient records ... Texas Health Action is seeking a Nurse Practitioner or Physician Assistant at our Central Texas Austin Kind Clinic's...consultation with and under direct supervision of the attending Physician . This is a full-time, exempt position requiring 40… more
- 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
- Healthfirst (NY)
- **Duties//Responsibilities:** + **The Medical Peer Reviewer will assess// review requests for authorization, and claims payment, based on medical records and ... and make informed clinical judgments and recommendations.** + **The Medical Peer Reviewer will render determinations in the format and within timeframes to follow… 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 (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
- State of Michigan (Lansing, MI)
- …To identify psychotropic medication regimens that require additional physician review according to policy, the Utilization Reviewer actively monitors ... to identify foster care individuals with psychotropic medication regimens that require additional physician review , preparing the physician review … more
- Rochester Regional Health (Rochester, NY)
- …least two MBS Committee meetings annually, one of which must be the annual comprehensive review meeting. + The MBS Clinical Reviewer must be present and actively ... Office Building Hours Per Week: 40Schedule: Monday-Friday, 8am-4:30pm SUMMARY:MBS Clinical Reviewer is required to fulfill case abstraction duties, complete ongoing… more