- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …appropriate. At the request of the Senior Medical Director of the Physician Review Unit (PRU), the reviewer also provides clinical leadership in other areas ... your true colors to blue. The Role The Physician Reviewer is responsible for evaluating pre & post-service clinical...as determined by plan benefit design, plan riders, and medical necessity criteria. In making coverage decisions regarding level… more
- Healthfirst (NY)
- **Duties//Responsibilities:** + **The Medical Peer Reviewer will assess// review requests for authorization, and claims payment, based on medical records ... based on changing needs of the organization.** **Weekday Requirements:** + **The Medical reviewer requires 25 hours a week of coverage//5 days per week.** +… more
- State of Colorado (Denver, CO)
- Administrative Reviewer Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5163518) Apply Administrative Reviewer Salary $5,962.00 - ... below for details! (https://dhr.colorado.gov/state-employees/state-of-colorado-employee-benefits) About this Unit: The Administrative Review Division's (ARD) vision is to create a safe… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas of ... your true colors to blue. The Role The Physician Reviewer is responsible for evaluating clinical service requests made...+ Perform additional tasks as assigned by the Associate Medical Director of the Physician Psychologist Review … 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 ... document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, and… more
- AECOM (Sacramento, CA)
- …**Job Description** **AECOM** is seeking an **Assistant Project Manager - Utility Design Reviewer ** to work **remotely** . The client is located in Sacramento, CA ... of Investigation ("ROI") and the Utilities Senior Project Manager, the Utility Design Reviewer contributes alongside a team of Utility Design Reviewers to prepare, … more
- Chenega Corporation (Rockville, MD)
- …Professional Services Strategic Business Unit** company, is looking for a Physician- Contract Medical Reviewer (CMR) to support the Department of Health and ... innovative solutions for our clients. **Responsibilities** + Serve as Contract Medical Reviewers who write medical eligibility determination recommendations via… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …conduct billing compliance investigations as required, which may include audits designed to review the adequacy of medical record documentation to support claims ... to the Director of Billing Compliance, the Senior Billing Compliance Reviewer ensures the integrity, accuracy, and regulatory compliance of Dana-Farber Cancer… more
- Chenega Corporation (Rockville, MD)
- …Services Strategic Business Unit** company, is looking for a Nurse Practitioner-Contract Medical Reviewer (CMR) to support the Department of Health and ... innovative solutions for our clients. **Responsibilities** + Serve as Contract Medical Reviewers, to write medical eligibility determination recommendations via… more
- Hartford HealthCare (Hartford, CT)
- …than 30 different specialties. The primary responsibility of the Metabolic and Bariatric Surgical/ Medical Clinical Reviewer (MBSCR) is to ensure the accurate and ... And this is *your moment.* **Job:** **Administrative* **Organization:** **Hartford HealthCare Medical Group Specialists* **Title:** *Surgical Clinical Reviewer -… more