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Clinical Review Processor Jobs

Clinical Review Nurse Jobs
By Novitas At , Jacksonville, Fl
Short- and long-term disability benefits
Excellent written and oral communication skills
Demonstrated experience with evaluating medical and health care delivery issues
Strong computer skills to include Microsoft Office proficiency
Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
401(k) plan with company match and immediate vesting
Care Review Processor -Virginia (Remote)
By Molina Healthcare At , Long Beach, 90802, Ca $15.58 - $30.39 an hour

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

To all current Molina employees:

Manager Clinical Claim Review - Remote
By UnitedHealth Group At , Minnetonka, 55345, Mn $85,000 - $167,300 a year
Collaborate with physicians, claims operations, prior authorization, utilization management, local market teams and support staff as needed
Solid communication, presentation and writing skills
Solid knowledge of medical claims and medical necessity review processes
Intermediate experience using Microsoft Office applications (Word, Excel (pivot tables), PowerPoint)
Proven solid attention to detail and accuracy, excellent evaluative and analytical skills
2+ years of leadership experience
Care Review Processor -Virgina (Remote)
By Molina Healthcare At United States
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Provides telephone, clerical, and data entry support for the Care Review team.
Responds to requests for authorization of services submitted via phone, fax, and mail according to Molina operational timeframes.
Clinical Review Nurse Jobs
By Abbott Laboratories At , Kansas City, Mo
3-5 years’ minimum experience in Occupational health settings, hospital, and outpatient nursing
Career development with an international company where you can grow the career you dream of.
Free medical coverage for employees* via the Health Investment Plan (HIP) PPO
An excellent retirement savings plan with high employer contribution
Provide subject matter expertise in executing Drug Testing Services across Workplace Solutions broad customer base.
Interpret and report results of Workplace clients consistent with Workplace Solutions written Standard Operating Procedures.
Clinical Review Specialist Jobs
By Accreditation Commission for Health Care (ACHC) At United States
Experience working with computer systems with proficient use of database and other office system programs.
Strong oral and written communication skills and presentation skills.
This position is 100% remote and can be located anywhere nationwide.
Review Summary of Findings (SOF) documentation submitted by Surveyors, ensuring accuracy.
Complete the Company Review Form and present the findings of the survey to the Accreditation Review Committee.
Participate as an active member of the Accreditation Review Committee.
Clinical Review Rn Jobs
By Centers Plan for Healthy Living At Margate, FL, United States
3-5 years of home care experience
Strong knowledge of OASIS and Medicare/Medicaid guidelines
OASIS and or Coding certification preferred
Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations.
Reviews Outcome Assessment Information Set (OASIS) and visit documentation for errors and inconsistencies related to clinical documentation, including wounds
Applies ICD-10-CM coding rules and regulations to the review process.
Home Health Clinical Review Coordinator
By UnitedHealth Group At , Brentwood, 37027, Tn $32.60 - $63.99 an hour
2+ years of experience in utilization management role
Complete cross-training and maintain knowledge of multiple contracts/clients to support coverage needs across the business.
Perform other duties and responsibilities as required, assigned, or requested
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
More information can be downloaded at: http://uhg.hr/uhgbenefits
1+ years of experience working at a Medicare Certified home health agency
Clinical Quality Review Spececialist
By HCSC At , Chicago, Il
Knowledge of managed care processes.
Organizational skills and ability to meet deadlines and manage multiple priorities.
5 years combine knowledge of healthcare processes.
Verbal and written communication skills to include interfacing with staff across organizational lines plus interfacing with members and providers.
PC experience to include Microsoft Word, Access, and Excel.
Health claims and mainframe system experience.
Manager, Clinical Quality Review
By Blue Shield of California At , Woodland Hills, 91367, Ca $94,160 - $141,240 a year
Requires quality management, risk management, peer review, or grievance review experience
Manage performance and hiring processes of direct reports
Proficient in typing skills and in use of PC-based software programs including Microsoft Word and Excel
Excellent communication skills, both written and verbal
Understand and identify opportunities for process and workflow efficiencies and improvements
Collaborate with internal partners and lead CQR-related projects
Clinical Claim Review Rn - Medical Disability - Remote
By UnitedHealth Group At , Phoenix, 85002, Az $56,300 - $110,400 a year
Proficient computer skills including Microsoft Office programs and database experience
Remain up to date with the contract requirements
3+ years of experience in a clinical environment as a Registered Nurse
Understanding/knowledge of regulatory standards and their application to various examinations and documents
Experience working in an Electronic Medical Record system
Excellent verbal and written communication skills
Initial Clinical Review Remote Prior Um Health Plan Experience
By Blue Cross Blue Shield of Arizona At , Phoenix, 85021, Az
Knowledge of managed care, utilization management, and quality management
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests.
Participate in continuing education and current developments in the fields of medicine and managed care.
2 years of experience in clinical field of practice, health insurance, or other health care related field
3 years of experience in clinical field of practice, health insurance, or other health care related field
Communicate team issues and opportunities for improvement to supervisor/manager;
Clinical Quality Review Nurse
By Amerit Consulting At California, United States
Quality management, audits, risk management, peer review, grievance review or equivalent experience required
3-5+ years hands-on clinical nursing experience across a variety of specialties and settings required
Strong verbal/written communication and organizational skills
Pay Rate: $45/hr - $52/hr (depending on experience)
Prepares cases on-line using department database per departmental protocols. Case assignments may range from routine to complex in scope.
Presents PQI case review summaries/findings to Medical Director at weekly Case Review Meetings as appropriate.
Sr. Payment Integrity Clinical Review Specialist - Optumserve - Remote
By UnitedHealth Group At , Baltimore, 21240, Md $85,000 - $167,300 a year
3+ years of experience working in a government, legal, law enforcement, investigations, health care managed care, and/or health insurance environment
3+ years of clinical medical/surgical experience
Experience training and coaching other team members
Experience with Facets, iDRS, CSP, Macess, or other claims processing systems
Collaborate with a team that is triaging, investigating and medical reviewing instances of health care fraud and/or abusive conduct
Perform clinical review of medical record and claims data for PI cases
Care Review Processor Jobs
By Molina Healthcare At , , Ia $13.55 - $26.42 an hour

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

To all current Molina employees:

Review Appraisers Jobs
By All Native Group At , Arlington, 22209, Va
Participates on multidisciplinary teams for special purposes such as asset management planning, property development and site selection.
Conduct comparative studies to assess feasibility of rehabilitating existing properties to meet requirements or of disposing of and acquiring alternative properties;
Demonstrated experience in commercial real estate appraisal of complex multi-million dollar properties
Expertise and experience using accepted financial models for analyzing investment alternatives
Five to nine years of applicable experience
Review and analyze complex reports for the impact of recommendations on Department and Bureau policies, goals, and objectives;
Appraisal Review Officer Jobs
By Citizens Business Bank At , Ontario, 91764, Ca $127,475 - $184,838 a year
Continual development of local market knowledge and national real estate trends.
Provide, present, and promote The Citizens Experience to all external and internal customers.
This job has no supervisory responsibilities.
Complies with and stays abreast of all policies and procedures, federal and state laws applicable to the job.
Understands the current edition of USPAP, as well as the Bank’s appraisal policy and guidelines.
Learning and performing the administrative tasks that leads to effective and efficient Appraisal Review process.
Clinical Review Nurse I (Us)
By Elevance Health At , Indianapolis, 46204, In
Experience with Prior Authorization preferred.
Job Family: Medical and Clinical
Date Posted: Apr 04, 2023
Current unrestricted RN license required.
Ability to comprehend medical policy and criteria to clearly articulate health information strongly preferred.
Primary duties may include, but are not limited to:

Are you looking for a job that will allow you to use your medical knowledge and experience to help improve patient care? If so, then a Clinical Review Processor position may be the perfect fit for you! As a Clinical Review Processor, you will be responsible for reviewing medical records and making sure they are accurate and up-to-date. You will also be responsible for ensuring that all medical information is properly documented and that all patient care is in compliance with applicable regulations. If you are looking for a rewarding career that will allow you to make a difference in the lives of patients, then this is the job for you!

Overview:

A Clinical Review Processor is responsible for reviewing and processing clinical data to ensure accuracy and compliance with established standards. They are responsible for verifying the accuracy of clinical data and ensuring that all data is properly documented and stored. They also review and analyze clinical data to identify trends and patterns that may be of interest to healthcare providers.

Detailed Job Description:

A Clinical Review Processor is responsible for reviewing and processing clinical data to ensure accuracy and compliance with established standards. They are responsible for verifying the accuracy of clinical data and ensuring that all data is properly documented and stored. They also review and analyze clinical data to identify trends and patterns that may be of interest to healthcare providers. They must be able to interpret and analyze data to identify any discrepancies or errors. They must also be able to communicate effectively with healthcare providers and other stakeholders to ensure that all data is accurate and up to date.

What is Clinical Review Processor Job Skills Required?

• Knowledge of medical terminology and clinical data
• Strong analytical and problem-solving skills
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Proficiency in Microsoft Office Suite
• Ability to work with large amounts of data
• Attention to detail and accuracy

What is Clinical Review Processor Job Qualifications?

• Bachelor’s degree in a related field
• Previous experience in a healthcare setting
• Knowledge of medical coding and billing
• Knowledge of HIPAA regulations

What is Clinical Review Processor Job Knowledge?

• Knowledge of medical terminology and clinical data
• Knowledge of medical coding and billing
• Knowledge of HIPAA regulations
• Knowledge of data analysis and reporting

What is Clinical Review Processor Job Experience?

• Previous experience in a healthcare setting
• Experience working with large amounts of data
• Experience with data analysis and reporting

What is Clinical Review Processor Job Responsibilities?

• Review and process clinical data to ensure accuracy and compliance with established standards
• Verify accuracy of clinical data and ensure that all data is properly documented and stored
• Review and analyze clinical data to identify trends and patterns
• Interpret and analyze data to identify any discrepancies or errors
• Communicate effectively with healthcare providers and other stakeholders to ensure that all data is accurate and up to date
• Maintain accurate records and documentation of all clinical data