- 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 ... transform healthcare? Bring your true colors to blue. The Physician Reviewer is responsible for evaluating clinical..., in partnership with case managers + Participate in Physician Psychologist Review Units' appeal process of… more
- 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 ... Ready to help us transform healthcare? Bring your true colors to blue. The physician reviewer is responsible for evaluating pre & post-service clinical service… more
- BayCare Health System (Tampa, FL)
- …the Utilization Physician Reviewer is to optimize utilization physician review coverage resulting in reduction of inappropriate prolonged observation ... foundation of trust, dignity, respect, responsibility and clinical excellence. **Utilization Physician Reviewer position details:** + **Facility:** St. Joseph's… more
- Commonwealth Care Alliance (Boston, MA)
- …of community-based assessments for CCA members and ongoing tracking and monitoring. The RN MDS Reviewer is a member of the Minimum Data Set (MDS) Clinical Review ... team of the Care Planning Unit. The RN MDS Reviewer supports successful completion and submission of the MDS...form based on diagnoses / information gathered from record review . + Prepares printed MDS forms for data entry.… more
- Apex Health Solutions (Houston, TX)
- …as a contact and resource person to Health Solutions' members for the utilization review (UR) of healthcare services. The UM Reviewer will be responsible for ... well as carrying out day today pre-authorization functions. The Utilization Review Nurse will also be responsible for issuing pre-authorization approvals/denials,… more
- HCA Healthcare (Nashville, TN)
- …invested over 156,000 hours volunteering in our communities. As a Coding Quality Audit Reviewer with Work from Home you can be a part of an organization that ... We are looking for an enthusiastic Coding Quality Audit Reviewer to help us reach our goals. Unlock your...result in appropriate reimbursement and data integrity. You will review outcomes are communicated to the HSC team to… more
- Evolent (Lansing, MI)
- …where required, refers all cases that an approval cannot be rendered to the Physician Clinical Reviewer . In States where allowed, will make denial determinations ... Stay for the culture. **What You'll Be Doing:** Clinical Reviewer , Speech Therapy As a Clinical Reviewer ,...health outcomes. **Collaboration Opportunities: ** Functions in a clinical review capacity to evaluate all cases, which do not… more
- Elevance Health (Grand Prairie, TX)
- …determining whether clinical information presented meets medical necessity criteria or requires physician review or override. + Clearly and concisely documenting ... **JR139503 Genetic Counselor Reviewer ** The genetic counselor reviewer (GCR) is...clinical review and other case interactions in online database in adherence… more
- SSM Health (MO)
- …Preferred Qualifications: CCDS certification Prior experience as a Second Level Reviewer Prior experience reviewing PSI (patient safety indicator) or experience with ... to clinical staff regarding these requirements during the concurrent record review process. + Maintains knowledge of mortality models, observed rate/expected rate… more
- University of Miami (Hialeah, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... Concurrent Quality Reviewer of our hospital reviews documentation in the electronic...Documentation Specialists for concurrent queries to the providers, ensuring physician responses to queries are reflected in the code… more