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Clinical Reviewer – Remote Jobs

Content Reviewer (Part-Time - Remote)
By Tech Firefly At Texas, United States
Must be able to perform tasks quickly and accurately with excellent time management skills
High School or GED minimum education
Excellent communication skills (both written & oral)
Good interpersonal skills to be able to perform in both teamwork and independent environments
Strong independent judgment and decision-making abilities with established guideline
Excellent technical and computer skills
Content Reviewer (Part-Time - Remote)
By Tech Firefly At California, United States
Must be able to perform tasks quickly and accurately with excellent time management skills
High School or GED minimum education
Excellent communication skills (both written & oral)
Good interpersonal skills to be able to perform in both teamwork and independent environments
Strong independent judgment and decision-making abilities with established guideline
Excellent technical and computer skills
Seasonal Content Reviewer (Remote)
By Zazzle At Reno, NV, United States
Ensure that Zazzle does not offer or produce merchandise that is unauthorized or unlicensed.
Prevent offering or producing unauthorized merchandise.
0-2 years professional experience, and a High School Diploma.
Knowledge of technology, social media, and internet research.
Excellent communication skills, ability to receive feedback and act on it, work independently and collaboratively.
Review and identify designs that are copyrighted, trademarked, or protected by other forms of intellectual property rights.
Licensed Psychologist Peer Reviewer - Remote
By Optum At , Detroit, 48202
State - specific Medicaid services (e.g. Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment, etc.)
Experience working in a managed care setting
3+ years of post - licensure experience
Computer skills, including facility with Windows OS, Outlook, Word, Teams and Excel
ASPPB Certificate of Professional Qualification (CPQ)
Experience with Commercial, Medicaid and Medicare lines of business
Lead Clinical Pharmacist Reviewer- Remote
By Prime Therapeutics At , Remote $107,330 - $182,470 a year
Managed care, pharmaceutical sales management experience.
Management experience in the coordination of and collaboration of work teams.
Managed pharmacy benefits organization experience preferred.
Experience with pharmaceuticals in a pharmaceutical sales, retail, or managed care environment, including contact with physicians/prescribers.
Managed care pharmaceutical service experience plus experience with coaching physicians and prescribers on medication issues, especially on specialty medications.
Knowledge of current research related to specialty medications.-Strong research and implementation skills in practical settings.
Clinic Risk Nurse Reviewer (Remote)
By Mercy At , Oklahoma City, 73120
Experience: At least 1 year of clinical experience
Education: Associate's or Bachelor's Degree
*This is a Remote Position*
*Strongly Prefer HCC Coding Experience*
*Looking for Clinic Nurse Reviewer/Risk Coder*
We're bringing to life a healing ministry through compassionate care.
Clinical Detox Reviewer Rn
By CVS Health At , $28.25 - $60.50 an hour
Managed care/utilization review experience preferred
1+ years experience working in a clinical detox setting
3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
Experience working in subacute detox setting preferred
An active and good standing RN license for Arizona is required
Candidate must reside in Arizona to be considered.
Clinical Reviewer - Dme
By CareCentrix At , Remote
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.
Transcription Quality Reviewer - Health Information - Remote
By PeaceHealth At , Vancouver, 98683
Communicates results of QA checks to supervisor for use in management of MTSOs.
Basic computer skills including knowledge of MS Office applications
Knowledge of medical transcription guidelines and practices
Excellent written and verbal communication skills, including English usage, grammar, punctuation, and style
Working knowledge of Centricity Enterprise and Epic/CareConnect preferred.
Job duties frequently require intense concentration and attention to detail (up to 65% of work time).
Clinical Reviewer Jobs
By Numotion At Home, KS, United States
Six months medical documentation review related experience or training required.
Solid written and verbal communication, listening, organization and priority setting skills.
Maintain consistent and accurate follow-up on all assigned orders.
Communicate with Supervisor in regards to issues/changes with Payers.
Process all assigned orders in an accurate and timely manner.
Respond to all internal and external customers in a timely & professional manner
Ld Clinical Nurse Reviewer
By Phoenix Children's Hospital At , Phoenix
Collaborates with Lead Case Manager, Case Management Manager, Care Management Director and Utilization Medical Director.
Evaluates performance of Utilization Management technician and assists in completing performance appraisals.
Leveraging MCG evidence-based guidelines, coordinates, development and implementation of a comprehensive plan in collaboration with the Case Management Team.
Communicates with Utilization Management Leadership denials requiring a physician to physician conversation.
Attends insurance meetings with Utilization Management Medical Director and Care Management leadership as needed.
Attends Utilization Management meetings with Utilization Management Medical Director and Care Management leadership as needed.
Lpn Clinical Claims Reviewer (Hybrid/Remote Position)
By Chapters Health System At , Temple Terrace, 33637, Fl
Ensures departmental compliance with quality managements system and ISO requirements.
Improve own professional knowledge and skill level.
Minimum of two (2) years of hospice, palliative care, home health primary, and specialty care experience
Familiarity with Medicare, Medicaid, commercial and CMS managed care initiatives
Experience in Microsoft Outlook, Excel and Word
Excellent written and verbal communication skills
Transcription Quality Reviewer - Health Information - Remote
By PeaceHealth At Vancouver, WA, United States
Communicates results of QA checks to supervisor for use in management of MTSOs.
Basic computer skills including knowledge of MS Office applications
Knowledge of medical transcription guidelines and practices
Excellent written and verbal communication skills, including English usage, grammar, punctuation, and style
Working knowledge of Centricity Enterprise and Epic/CareConnect preferred.
Job duties frequently require intense concentration and attention to detail (up to 65% of work time).
Clinical Programmer (Remote) Jobs
By Tandym Group At Princeton, NJ, United States
Communicate with programming and statistics leads, data managers and other team members
10+ years of statistical programming experience in the Pharmaceutical, Biotechnology, or Contract Research Industry
Strong SAS programming skills required in Windows & UNIX environment with proficiency in SAS/Base, SAS Macros, SAS/Stat
Excellent communication skills (written and verbal)
Knowledge of working in SAS Grid environment
Experience in SAS Enterprise Guide and SAS Studio
Appeals Reviewer (Remote) Jobs
By Capitol Bridge At , Remote $55,000 - $66,622 a year
Manage referral caseload and update weekly referral pending report.
At least three years of Medicare review or appeals experience.
Knowledge of Medicare policies and coverage issues and HCPCS coding.
Strong organizational, interpersonal, written, and verbal communication skills.
Conduct research on federal law, regulations, and CMS and contractor policies.
Collaborate with attorneys and the Medical Director to review new or complex issues, when necessary.
Clinic Risk Nurse Reviewer (Remote)
By Mercy At , Oklahoma City, 73120, Ok
Experience: At least 1 year of clinical experience
Education: Associate's or Bachelor's Degree
*This is a Remote Position*
*Strongly Prefer HCC Coding Experience*
*Looking for Clinic Nurse Reviewer/Risk Coder*
We're bringing to life a healing ministry through compassionate care.
Haq Clinical Reviewer - Remote | Wfh
By Get It Recruit - Healthcare At Walnut Creek, CA, United States

Are you ready to make a real impact in the world of healthcare? Join our dynamic Care Navigation department as a Health Assessment Questionnaire (HAQ) Reviewer and become an essential element in ...

Nurse Reviewer - Remote
By The Computer Merchant, LTD (TCM) At Anchorage, AK, United States

JOB TITLE:Nurse Reviewer - Remote

Clinical Reviewer - Medicare
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 Reviewer - Dme
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.

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