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Clinical Review Processor Jobs

Care Review Processor Pst Hours, Including Weekends - Day Shift (4 10)
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.
Care Review Processor PST Hours, Including Weekends - Day Shift (4 10)
Department Operates 7 days a week, Monday – Sunday
Training schedule: Monday - Friday 8:00 AM - 5:00 PM PST
Care Review Processor - Pst Hours, Including Weekends - Rotating Weekend And Overnight Shifts
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.
Care Review Processor - PST Hours, Including Weekends - Rotating Weekend and Overnight Shifts
Department Operates 7 days a week, Monday – Sunday
Training schedule: Monday - Friday 8:00 AM - 5:00 PM PST
Care Review Processor - Pst Hours, Including Weekends, Mid Shift (4 10)
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.
Care Review Processor - PST Hours, Including Weekends, Mid Shift (4 10)
Department Operates 7 days a week, Monday – Sunday
Training schedule: Monday - Friday 8:00 AM - 5:00 PM PST
Care Review Processor - Pst Hours, Including Weekends - Night Shifts (4 10)
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.
Care Review Processor - PST Hours, Including Weekends - Night Shifts (4 10)
Department Operates 7 days a week, Monday – Sunday
Training schedule: Monday - Friday 8:00 AM - 5:00 PM PST
Care Review Processor – Pacific Standard Time Hours - Day Shifts (Weekends Included)
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.
Care Review Processor – Pacific Standard Time Hours - Day Shifts (Weekends included)
Department Operates 7 days a week, Monday – Sunday
Training schedule: Monday - Friday 8:00 AM - 5:00 PM PST
Clinical Quality Review Specialist
By Trinity Health At Home At Springfield, PA, United States
ICD10 HCS-D certification strongly preferred.
Home Care Home Base software experience a plus!
Strong computer and technology skills required.
About Trinity Health At Home
Degree: Bachelor's preferred. Associate nursing degree considered if successfully demonstrated career progression and meets and exceeds performance expectations.
Ability to consistently demonstrate alignment to the Mission, Vision and Values, Organizational Code of Ethics and adhere to the Compliance Program.
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 & Documentation Review Consultant
By Kaiser Permanente At Oakland, CA, United States
Must be able to work in a Labor/Management Partnership (union) environment.
Bachelor's degree in health information management, business administration, healthcare administration or other related field.
Acts as the Reg-l coding contact person for the HIM Dept to support Edu & coding requirements.
High School Diploma or General Education Development (GED) required.
Demonstrated strong interpersonal and communication skills.
Working knowledge of Hierarchical Condition Category (HCC) coding and reimbursement methodology.
Care Review Processor - Remote (Night Shift)
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.
Shift 10:30pm - 6:30am Saturdays Mandatory
Responds to requests for authorization of services submitted via phone, fax, and mail according to Molina operational timeframes.
Pay Range: $12.87 - $25.10 an hour *
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
Processor, Cob Review Jobs
By Molina Healthcare At United States
Provides telephone, clerical, and data entry support for the COB team.
Phones or utilizes other insurance company portals to validate state, vendor, and internal COB leads.
Updates the other insurance table on the claims transactional system and COB tracking database.
Clinical Laboratory Processor Jobs
By Skagit Regional Health At , Mount Vernon, 98273, Wa $30.10 an hour

Six (6) months previous hospital lab experience preferred.

High School graduate or GED required.

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

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