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Clinical Review Pharmacist Jobs

Clinical Review Pharmacist Lead
By SmithRx At , Remote
5+ years of health plan or pharmacy benefit manager experience, specifically involved in prior authorization review
2-3+ years of management experience
Directly manage, coach, and mentor a team of prior authorization Pharmacists
Manage team to meet target KPIs associated with our operating model
Cross-functional collaboration with other departments including troubleshooting eligibility questions, claims adjudication, and benefit designs
Drive quality member experiences by ensuring Clinical Review team policy and procedures are adhered to
Clinical Review Coordinator - National Remote
By Optum At , Dallas, 75202
2+ years of Case Management experience
Experience in acute care, rehab, OR skilled nursing facility environment
Ability to work effectively in a self- management environment
Support new delegated contract start - up to ensure experienced staff work with new contracts
Perform other duties and responsibilities as required, assigned or requested
3+ years of clinical experience
Manager Clinical Quality Review
By Johns Hopkins University At , Baltimore, 21218

EDUCATION LICENSURE & EXPERIENCE :

Benefits can be viewed here:

Medical Review Nurse (Government Outpatient Clinical Focus)
By Performant Financial Corporation At , Remote
Experience with utilization management systems or clinical decision making tools such as Medical Coverage Guidelines (MCG) or InterQual.
Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse
Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits
Strong preference for experience performing utilization review for an insurance company, Tricare, MAC or organizations performing similar functions
Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding.
Knowledge of insurance programs program, particularly the coverage and payment rules.
Medical Review Nurse (Government Outpatient Clinical Focus)
By Performant Corp At United States
Experience with utilization management systems or clinical decision making tools such as Medical Coverage Guidelines (MCG) or InterQual.
Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse
Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits
Strong preference for experience performing utilization review for an insurance company, Tricare, MAC or organizations performing similar functions
Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding.
Knowledge of insurance programs program, particularly the coverage and payment rules.
Clinical Review Nurse I
By Elevance Health At Hingham, MA, United States
Medicare Part B Appeals experience preferred.
Job Family: Medical and Clinical
Conducts investigations and reviews of member and provider grievances and appeals.
Generates appropriate written correspondence to providers, members, and regulatory entities.
Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.
Adapts to a wide variety of medical review topics in Part B appeals.
Clinical Review Nurse I
By Elevance Health At Atlanta, GA, United States
Medicare Part B Appeals experience preferred.
Job Family: Medical and Clinical
Conducts investigations and reviews of member and provider grievances and appeals.
Generates appropriate written correspondence to providers, members, and regulatory entities.
Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.
Adapts to a wide variety of medical review topics in Part B appeals.
Clinical Review Nurse Jobs
By Abbott At Kansas City, MO, United States
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 Coordinator - Remote | Wfh
By Get It Recruit - Healthcare At Dallas, TX, United States

We are seeking a passionate and dedicated healthcare professional to join our dynamic team! As a member of our organization, you will play a pivotal role in ensuring the highest quality of care for ...

Clinical Review Coordinator - National Remote
By RemoteWorker US At Hartford, CT, United States
2+ years of Case Management experience
Experience in acute care, rehab or skilled nursing facility environment
Ability to work effectively in a self-management environment
Support new delegated contract start-up to ensure experienced staff work with new contracts
Perform other duties and responsibilities as required, assigned or requested.
3+ years of clinical experience
Clinical Review Pharmacy Technician Manager
By SmithRx At ,
5+ years of health plan or pharmacy benefit manager experience, specifically involved in prior authorization review
3-5+ years of management experience
Directly manage, coach, and mentor a team of prior authorization technicians
Manage team to meet target KPIs associated with our operating model
Cross-functional collaboration with other departments including troubleshooting eligibility questions, claims adjudication, and benefit designs
Drive quality provider and member experiences by ensuring policy and procedures are adhered to
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
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
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.
Remote Order Entry Review Pharmacist
By SPECIALTY RX INC. At , Ridgefield Park, 07660, Nj $48 an hour
Remote Order Entry Review Pharmacist Requirements:
Must successfully complete 4 consecutive weeks of training at out Ridgefield Park, NJ location and will then transition to remote.
Previous experience in Long Term Care is preferred.
Strong analytical and critical thinking skills.
Computer literate, knowledge of Frameworks LTC system, PLUS
Remote Order Entry Review Pharmacist
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

Are you looking for a challenging and rewarding career as a Clinical Review Pharmacist? Join our team and help us make a difference in the lives of our patients! We offer competitive salaries and benefits, and the opportunity to work with a dynamic and experienced team of professionals.

A Clinical Review Pharmacist is responsible for reviewing and evaluating medication orders for accuracy, safety, and appropriateness. They also provide medication-related consultation to healthcare providers and patients.

What is Clinical Review Pharmacist Skills Required?

• Knowledge of pharmacology, pharmacotherapeutics, and medication safety
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Strong problem-solving and critical thinking skills
• Ability to interpret and analyze medical data
• Knowledge of applicable laws and regulations

What is Clinical Review Pharmacist Qualifications?

• Pharm.D. degree from an accredited college of pharmacy
• State licensure as a pharmacist
• Certification in a specialty area of pharmacy (e.g. ambulatory care, geriatrics, etc.)

What is Clinical Review Pharmacist Knowledge?

• Knowledge of drug interactions, contraindications, and side effects
• Knowledge of medication formulary and therapeutic guidelines
• Knowledge of medical terminology and abbreviations
• Knowledge of computer systems and software used in pharmacy

What is Clinical Review Pharmacist Experience?

• Previous experience in a clinical setting
• Previous experience in a pharmacy setting

What is Clinical Review Pharmacist Responsibilities?

• Review and evaluate medication orders for accuracy, safety, and appropriateness
• Provide medication-related consultation