Register
Recruit Create CV

Insurance Clinical Reviewer Jobs

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.
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
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 ...

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.
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 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
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.
Clinical Nurse Reviewer (Remote)
By Acentra Health At Harrisburg, PA, United States

Good Verbal And Written Communication Skills Essential.

Medical Record Abstracting Skills 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 (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 Pac - 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.
You should get in touch if: (experience & education):
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.
Clinical Reviewer (Rn) Jobs
By Noridian Healthcare Solutions At , Fargo, 58103, Nd
1 year experience utilization review or case management
* Position is eligible for Remote / Work from Home opportunity *
Communicates decisions and provides associated education to stakeholders using various methods.
1 year Microsoft Office experience
Strong verbal and written communication skills
1 year experience evaluating medical records applying clinical expertise to determine compliance with applicable guidelines and standards of care
Clinical Pharmacist Reviewer - Remote
By Prime Therapeutics At , Remote $107,330 - $182,470 a year
Management experience in the coordination of and collaboration of work teams preferred.
Managed care pharmaceutical service experience plus experience with coaching physicians and prescribers on medication issues, especially on specialty medications.
Managed care experience preferred.-Experience with pharmaceuticals in a pharmaceutical sales, retail, or managed care environment, including contact with physicians/prescribers preferred.
Managed pharmacy benefits organizations preferred.
5 years' experience in clinical pharmacy with emphasis in specialty pharmacy and oncology.
Knowledge of current research related to specialty medications.
Clinical Reviewer Therapist Jobs
By One Call At , $66,100 - $109,100 a year
Utilizes and maintains general knowledge of insurance reimbursement and specific knowledge of One Call Care Management processes
Must have the ability to work with and have knowledge of the physician community, managed care, pre-certification, and utilization review.
GENERAL KNOWLEDGE, SKILLS & ABILITIES:
Performs miscellaneous tasks and projects as assigned by management.
Opportunities to work from home
Tuition Reimbursement Program including certifications