- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …or providers as needed to gather clinical information to support the medical necessity review process and plan of care . + Support a positive workplace ... to gather clinical information to support the plan of care . + Monitor clinical...and NCQA requirements. + Refer to RN or PT Clinical Utilization reviewer for more complex cases… more
- Centers Plan for Healthy Living (Margate, FL)
- …applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help ... home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all...of members' care /social needs, developing a "living care plan " that is modified as needed,… more
- HCA Healthcare (Houston, TX)
- …their passion for patient care . Apply today for our Registered Nurse Clinical Reviewer opportunity. **Job Summary and Qualifications** We are seeking a ... apart from any other healthcare provider. We are seeking a(an) Registered Nurse Clinical Reviewer to join our healthcare family. **Benefits** The Woman's… more
- HCA Healthcare (Conroe, TX)
- …step in your career path, we encourage you to apply for our Registered Nurse Clinical Reviewer opening. We review all applications. Qualified candidates will ... you have the career opportunities as a(an) Registered Nurse Clinical Reviewer you want in your current...and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. +… more
- Monroe Plan for Medical Care (Rochester, NY)
- …access and quality of healthcare for underserved populations. For over 50 years, Monroe Plan for Medical Care , a not-for-profit health care services ... individuals and families who are recipients of government sponsored health insurance. Monroe Plan is the largest Care Management Agencies serving 28 counties and… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The Clinical Pharmacist Reviewer reviews formulary exception, prior authorization and quantity ... Participation in Prior Authorization, Formulary Exception, Step Therapy and Quality Care Dosing program implementation and management + Support Pharmacy Operations… more
- US Tech Solutions (Canton, MA)
- …The Clinical Reviewer will be expected to demonstrate sound clinical and health plan business knowledge in their decision making processes, on ... Notes: Fully remote, MA license required.** **Job Summary The Clinical Reviewer is a licensed professional -a...behalf of the health plan . **Key Responsibilities/Duties - what you will be doing**… more
- LGC Group (Petaluma, CA)
- …bioinformatics, biology, chemistry, manufacturing and analytical services that support discovery, pre- clinical and clinical trials and scale-up manufacture. With ... to cGMP of multigram to kilograms of API for pre- clinical and clinical development. Our site in...and analytical expertise in Kulmbach. Job Description The Technical Reviewer in LGC AxoLabs Quality Control is a hybrid… more
- The Cigna Group (Bloomfield, CT)
- …for Cigna. + Uses clinical knowledge to assess inpatient admission level of care , treatment plan and goals, identified gasps or risk for readmission or ... degree a plus + 3 years clinical experience in inpatient or managed care setting + Demonstrated ability to anticipate, plan , coordinate and organize. +… more
- The Cigna Group (Bloomfield, CT)
- …with the department Director. Responsible to perform prospective, retrospective and concurrent review consistent with eviCore clinical review protocols and ... experience Experience with pediatric and adult patients preferred Clinical review experience prefferred Strong computer skills...to be eligible to participate in an annual bonus plan . We want you to be healthy, balanced, and… more