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Clinical Reviewer – Remote Jobs

Clinical Reviewer - Medicare (Remote)
By CareCentrix At United States
You have experience working remotely and are self-motivated.
You hold strong knowledge of Medicare PDGM and 1-2 years process experience strongly desired.
Develops/maintains a working knowledge of all CareCentrix services/guidelines/policies and accesses CareCentrix contract information, including the terms of the contract as appropriate.
You manage multiple tasks, are detail oriented, responsive, and demonstrate independent thought and critical thinking.
You possess strong computer skills, including the ability to navigate multiple internal systems, programs and external sites to conduct reviews.
You have a minimum of 1-2 years prior authorization experience for Medicare or Medicare Advantage Home Health required.
Clinical Pharmacology Project Lead - 100% Remote
By Rangam At United States
Ability to effectively manage multiple tasks and projects with accelerated timelines is required.
Experience working with teams across global time zones is required.
Sound knowledge of pharmacokinetic and pharmacodynamic concepts, including noncompartmental analyses, is preferred.
Experience working with External Service Providers is preferred.
Experience with SharePoint, Excel, Microsoft Teams and OneNote is preferred.
Serve as a CPP departmental liaison for outsourcing and contribute to the implementation and execution of the sourcing strategy.
Clinical Data Reviewer Jobs
By Natera At Austin, TX, United States
Partner with multiple internal cross-functional teams and successfully manage multiple product projects simultaneously.
Complete position responsibilities within the appropriate time frame while adhering to quality standards
Translate data into meaningful information and knowledge that supports decision making or determining action that drives performance improvement and quality
1+ years professional coding experience and understanding of International Classification of Diseases (ICD-10) and Coding Procedure Terminology (CPT) and HCPCS coding.
Superior organization skills, detail oriented, and ability to be persistent and follow through
Excellent communication skills, both verbal and written, particularly the ability to convey technical information in an accessible and understandable manner
Clinical Reviewer (Lpn/Rn - Remote)
By Acentra Health At Indianapolis, IN, United States
Are you an experienced Nurse Clinical Reviewer looking for a new challenge?
Strong clinical assessment and critical thinking skills required
Knowledge of InterQual or ASAM guidelines
Knowledge of InterQual or ASAM criteria strongly preferred
Knowledge of current NCQA/URAC standards strongly preferred
Excellent written and verbal communication skills
Remote Clinical Assistant Jobs
By Vail Health At United States
Pay is based upon relevant education and experience.
Manage provider’s patient portal messages, sort to appropriate inboxes within the EHR or address messages as needed.
Minimum of 2 years experience with applicable patient care and administrative duties preferred
Basic knowledge of medical terminology, medical equipment, HIPAA compliance and OSHA rules and regulations.
Medical Assistant Certification (MAC) by the American Medical Certification Association
Competitive Wages & Family Benefits:
Clinical Data Manager / Medical Reviewer
By Albion Rye Associates At United States
Clinical Data Manager / Medical Reviewer
Contract until 31st December 2023
Please contact Jake Byrne at Albion Rye for more information or apply now for immediate consideration.
Medical/Safety Reviewer - Remote
By Synectics Inc. At United States
Gain understanding of risk management regulations, standards, and guidance for medical devices and combination products.
Support medical safety consultation activities in matters related to risk/benefit and proper product safety usage as needed.
Knowledge of electronic databases (e.g., TrackWise, Business Objects, Oracle, Argus, other database tools)
Ability to Meet Challenging Milestones with results orientation – Skilled
Strategic Decision Making and Negotiation – Skilled
Facilitating Change and managing conflicts – Skilled
Clinical Program Analyst - Remote
By Prime Therapeutics At Minneapolis, MN, United States
Knowledge or experience with formulary or utilization management
3 years of PBM, Managed Care or Pharmaceutical/Trade experience
Could report to Sr Principal or VP in the Clinical Program Management department
Could report to Manager in the Network Management department
Support the RFP and implementation process by gathering information and requirements and communicating status updates to key business partners
Excellent organizational and communication skills
Clinical Nurse Reviewer (Remote)
By Acentra Health At Harrisburg, PA, United States

Good Verbal And Written Communication Skills Essential.

Medical Record Abstracting Skills Required.

Remote Clinical Assistant ($17.00 - $18.00 / Hour)
By Talentify.io At United States
Experience or accreditation in areas of food service, janitorial, and camp management systems such as Orissa
Oversee all facilities, property, and project management services required by the contract and requested by the client.
3-4 years of Assistant General Manager/Hospitality experience
Post-Secondary education in Business or Hospitality, or relevant work experience
Strong financial acumen and contract management
Knowledge of health and safety regulations, quality control, custodial, grounds, office services, managing third-party contracts, and continuous improvement
Clinical Coordinator (Remote) Jobs
By RITE AID At Yocumtown, PA, United States
An intelligent and articulate individual who can relate to people at all levels of an organizations and possesses excellent communication skills
Sound technical skills, analytical ability, good judgement, and strong operational focus
Demonstrated ability to manage multiple priorities and deadlines
Assist with formulary file preparation, quality control and submission
Assist with adjudication list maintenance and reporting requests
Assist with analysis of impact reports and member mailings
Nurse Reviewer - Remote
By Fortuna BMC At United States
Assists management with training new Nurse Reviewers to include daily monitoring, mentoring, feedback and education.
Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
Performs prior authorization, precertification, and retrospective reviews and prepares decision letters as needed in support of the utilization review contract
Maintains current knowledge of clinical criteria guidelines and successfully completes required CEUs to maintain RN license
Demonstrated proficiency in computer skills, and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers, etc.
5+ years clinical experience in an inpatient hospital setting required
A&G Clinical Coordinator - 100% Remote
By Healthfirst At Georgia, United States
Complete all associated data entry and authorization creation in the True care system.
Knowledge of related NY state and federal regulations highly desirable
Knowledge of the New York state ART 44 PHL and federal regulatory environment
Knowledge of claims payment process and claims data system (MHS)
Prepare cases for the clinical team by gathering documentation, loading evidence, and making calls to members and providers.
Perform administrative activities including but not limited to generating and printing determination and authorization notification letters.
Nurse Reviewer - Remote
By Fortuna BMC At Cochiti Pueblo, NM, United States
Assists management with training new Nurse Reviewers to include daily monitoring, mentoring, feedback and education.
Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
Performs prior authorization, precertification, and retrospective reviews and prepares decision letters as needed in support of the utilization review contract
Maintains current knowledge of clinical criteria guidelines and successfully completes required CEUs to maintain RN license
Demonstrated proficiency in computer skills, and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers, etc.
5+ years clinical experience in an inpatient hospital setting required
Clinical Reviewer (Remote) Jobs
By Acentra Health At Charleston, SC, United States
Do you value care management and quality improvement?
Are you an experienced Clinical Reviewer looking for a new challenge?
Active unrestricted RN, SC State and/or Compact State clinical license per contract requirements.
Knowledge of InterQual criteria strongly preferred.
Knowledge of current NCQA/URAC standards strongly preferred
Medical record abstracting skills required.
Clinical Reviewer (Utilization Review - Rn) - Remote Within Florida
By Acentra Health At Tampa, FL, United States
Do you value care management and quality improvement?
Are you an experienced Clinical Reviewer looking for a new challenge?
Performs ongoing reassessment of review process to offer opportunities for improvement and/or change.
Active unrestricted RN applicable State and/or Compact State clinical license per contract requirements.
Knowledge of current NCQA/URAC standards strongly preferred.
Medical record abstracting skills required.
Clinical Reviewer (Part Time) - Remote
By Acentra Health At United States
Do you value care management and quality improvement?
Are you an experienced Clinical Reviewer looking for a new challenge?
Are you motivated, energetic, and excited to become part of the Acentra Health team?
Clinical Reviewer - Rn - (Remote)
By Acentra Health At Philadelphia, PA, United States
Managed Care and/or Case Management experience preferred.
Do you value care management and quality improvement?
Are you an experienced Clinical Reviewer looking for a new challenge?
Performs ongoing reassessment of review process to offer opportunities for improvement and/or change.
Bachelor’s degree or advanced certifications preferred.
Knowledge of current NCQA/URAC standards strongly preferred
Clinical Reviewer - Immediate Advocacy - (Social Worker, Rn/Lpn)-Remote
By Acentra Health At Harrisburg, PA, United States
Do you value care management and quality improvement?
Are you an experienced Clinical Reviewer looking for a new challenge?
Performs ongoing reassessment of review process to offer opportunities for improvement and/or change.
Active unrestricted LPN, RN, Social Worker or other applicable State and/or Compact State clinical license per contract requirements.
Knowledge of InterQual criteria strongly preferred.
Knowledge of current NCQA/URAC standards strongly preferred.
Director, Clinical Operations - Clinical Development, Remote Us
By POINT Biopharma At Boston, MA, United States
Experience in supporting the development of RFPs, selection of CROs/vendors, and management of external resources
Review and approve Clinical Operations POINT or vendor documents (e.g. Monitoring Plan, Project Plan, TMF Management plan etc.)
7+ years of direct line management required; inclusive of talent identification, development, mentoring and performance management.
Proven success in leading and coordinating cross-functional clinical operations teams. (e.g., clinical operations, data management, clinical supply chain)
Knowledge and experience with developing, negotiating, and managing contracts (vendor and site)
Understands and manages project/program inter-dependencies to achieve program milestones/deliverables.

Are you looking for an exciting opportunity to use your clinical expertise to make a difference in the healthcare industry? We are looking for a Clinical Reviewer to join our remote team and help us ensure the highest quality of care for our patients. As a Clinical Reviewer, you will be responsible for reviewing medical records and making sure they meet the standards of our organization. You will also be responsible for identifying any potential issues and making recommendations for improvement. If you are passionate about healthcare and have the skills to make a difference, then this is the job for you!

Overview Clinical Reviewer – Remote is a position that involves reviewing medical records and other clinical data to ensure accuracy and compliance with applicable regulations. The Clinical Reviewer will be responsible for assessing the quality of care provided to patients, identifying any potential risks or issues, and providing recommendations for improvement. The Clinical Reviewer will also be responsible for providing feedback to providers and other stakeholders on the quality of care provided. Detailed Job Description The Clinical Reviewer – Remote is responsible for reviewing medical records and other clinical data to ensure accuracy and compliance with applicable regulations. The Clinical Reviewer will assess the quality of care provided to patients, identify any potential risks or issues, and provide recommendations for improvement. The Clinical Reviewer will also provide feedback to providers and other stakeholders on the quality of care provided. The Clinical Reviewer will be responsible for ensuring that all medical records are accurate and up-to-date, and that all clinical data is collected and stored in accordance with applicable regulations. The Clinical Reviewer will also be responsible for monitoring and evaluating the performance of providers and other stakeholders, and providing feedback on any areas of improvement. Job Skills Required
• Knowledge of medical terminology and clinical data
• Knowledge of applicable regulations and standards
• Ability to analyze and interpret medical records and other clinical data
• Ability to identify potential risks and issues
• Ability to provide feedback and recommendations for improvement
• Excellent communication and interpersonal skills
• Strong organizational and time management skills
• Ability to work independently and as part of a team
Job Qualifications
• Bachelor’s degree in a related field
• At least 3 years of experience in a clinical setting
• Certification in a related field (e.g. CCS, CPC, etc.)
• Knowledge of medical terminology and clinical data
• Knowledge of applicable regulations and standards
• Ability to analyze and interpret medical records and other clinical data
• Ability to identify potential risks and issues
• Excellent communication and interpersonal skills
Job Knowledge
• Knowledge of medical terminology and clinical data
• Knowledge of applicable regulations and standards
• Ability to analyze and interpret medical records and other clinical data
• Ability to identify potential risks and issues
• Knowledge of quality assurance and improvement processes
Job Experience
• At least 3 years of experience in a clinical setting
• Experience in medical record review and analysis
• Experience in providing feedback and recommendations for improvement
• Experience in monitoring