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Clinical Review Specialist Jobs

508 Compliance Review Specialist Jobs
By Aetos Systems, Inc. At Huntsville, AL, United States
Effective communication, organization, time management, and problem-solving skills
Knowledge of 508 requirements for applications and the ability to apply principles of accessibility to create Section 508 presentations
Ability to apply 508 best practices, along with knowledge of various testing methods
In-depth knowledge of web-based applications and documents
Excellent oral and written communication skills
In-depth 508c Accessibility document review experience
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.
Utilization Review Clinical Specialist (Remote)
By CHS Corporate At , Franklin, 37067

Computer Skills Required: Data entry skills; Demonstrable skills with Google Docs, Google Sheets, and email applications.

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:

Clinical Quality Review Specialist - Rn
By HCSC At , Richardson
Knowledge of managed care processes.
Organizational skills and ability to meet deadlines and manage multiple priorities.
Proficient with Milliman Care Guidelines (MCG) management.
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.
Clinician Review Specialist Jobs
By Nursa At Murray, UT, United States
Review resumes to assess candidates' qualifications, work experience, and nursing skills.
In-depth knowledge of nursing roles, responsibilities, and specializations.
Conduct initial phone screenings and interviews to further evaluate candidates' compatibility with our partner healthcare facilities’ requirements.
Provide a positive and professional experience for candidates, keeping them informed and engaged.
Familiarity with hospital-specific nursing requirements and the ability to match candidates to appropriate positions.
Ability to analyze candidate qualifications and assess their suitability for various nursing roles.
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.
Env-Iv Design Review Specialist
By NHDES Drinking Water and Groundwater Bureau, Concord NH At Concord, NH, United States

Reviews and approves modifications and new small non-community water systems such as restaurants, daycares and schools including treatment for common groundwater contaminants, and performs ...

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 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
Utilization Review Clinical Specialist
By CHS Corporate At , Franklin, Tn
Computer Skills Required: Data entry skills; Demonstrable skills with Google Docs, Google Sheets, and email applications.
Location FRANKLIN, TN (CHS Corporate)Full Time
Location FRANKLIN, TN (CHS Corporate)
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
Scope Review Specialist Jobs
By Avenue One At United States
● 2 years of construction related project management experience and/or budgets or estimating.
● Conflict resolution and conflict management experience.
● 100% employer-paid benefits (dental, health, medical, vision)
● 5 years of construction experience, preferably in residential and renovations.
● Prior home inspection/licensed inspector experience preferred.
● Experience with photoshop, 20/20 layout or photo editing software is preferred
Qa Review Specialist Jobs
By Verisma At , Remote
2 years’ experience in a professional office environment or healthcare setting, preferred with medical terminology knowledge
Proactively communicates with Manager or Supervisor regarding further clarification and when additional work is needed.
Communicates with Release of Information Specialists and Client Site Managers on issues pertaining to quality review.
HS Diploma or equivalent, additional education in Health Information is preferred
RHIT certification, CHDA certification or the ability to take and pass the course is preferred
Knowledge of HIPAA and state regulations related to the release of Protected Health Information, preferred
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.

Are you looking for a challenging and rewarding role in healthcare? Join our team as a Clinical Review Specialist and help us provide quality care to our patients!

Overview:

A Clinical Review Specialist is a healthcare professional who is responsible for reviewing medical records and other documents to ensure accuracy and compliance with applicable laws and regulations. They are also responsible for making sure that the medical records are up to date and complete.

Detailed Job Description:

Clinical Review Specialists are responsible for reviewing medical records and other documents to ensure accuracy and compliance with applicable laws and regulations. They must be able to interpret medical terminology and understand the implications of medical decisions. They must be able to identify discrepancies in medical records and take appropriate action. They must also be able to communicate effectively with healthcare providers and other stakeholders.

What is Clinical Review Specialist Job Skills Required?

• Knowledge of medical terminology and coding
• Ability to interpret medical records and documents
• Ability to identify discrepancies in medical records
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Ability to work with a variety of stakeholders
• Knowledge of applicable laws and regulations
• Knowledge of medical billing and reimbursement

What is Clinical Review Specialist Job Qualifications?

• Bachelor’s degree in a healthcare-related field
• Certification in medical coding and billing
• Experience in a healthcare setting
• Knowledge of medical terminology and coding
• Knowledge of applicable laws and regulations

What is Clinical Review Specialist Job Knowledge?

• Knowledge of medical terminology and coding
• Knowledge of applicable laws and regulations
• Knowledge of medical billing and reimbursement
• Knowledge of medical records and documentation

What is Clinical Review Specialist Job Experience?

• Experience in a healthcare setting
• Experience in medical coding and billing
• Experience in medical records and documentation

What is Clinical Review Specialist Job Responsibilities?

• Review medical records and other documents to ensure accuracy and compliance with applicable laws and regulations
• Interpret medical terminology and understand the implications of medical decisions
• Identify discrepancies in medical records and take appropriate action
• Communicate effectively with healthcare providers and other stakeholders
• Maintain up-to-date and complete medical records
• Ensure accuracy of medical billing and reimbursement