- Kepro (CA)
- …to being a vital partner for health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team in California. Job ... Summary As a Utilization Clinical Reviewer , you'll harness...a pivotal role in upholding industry benchmarks. This full-time Clinical Reviewer Remote position based… more
- Kepro (AR)
- … Reviewer to join our growing team. Summary Description The Dental Clinical Specialist is responsible for the Utilization Management and Utilization ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Long Term Services & Support Utilization Management Clinical Educator, RN** Location: Remote , United States Primary Job Function: Medical Management ID**: ... www.amerihealthcaritas.com. As part of the Community Health Choices LTSS Utilization Management (UM) Review Team, the [...risk of noncompliance related to the outcome of UM reviewer decisions. This role will serve as a critical… more
- Kepro (Minneapolis, MN)
- …the public sector. Acentra is looking for a Utilization Management - Mental Health Clinical Reviewer to join our growing team. This is a Remote position ... Job Summary: The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract… more
- Prime Therapeutics (Washington, DC)
- …fuels our passion and drives every decision we make. **Job Posting Title** Physician Clinical Reviewer - GI- REMOTE **Job Description Summary** Key member of ... utilization management team, and provides timely medical review of service requests that do not initially meet...clinical determinations cannot be made by the Initial Clinical Reviewer . + Discusses determinations with requesting… more
- AmeriHealth Caritas (Philadelphia, PA)
- ** Clinical Care Reviewer , Pediatric Shift Care, Registered Nurse** Location: Philadelphia, PA Primary Job Function: Medical Management ID**: 34518 Your career ... **Responsibilities:** Under the direction of the unit Supervisor, the Clinical Care Reviewer - Shift Care is responsible...Nurse working with medically fragile pediatric patients in a clinical setting. + 3+ years of Utilization … more
- WTW (Boston, MA)
- …issues or impact to timeline proactively to Project Manager + Complete initial review of carrier responses for parity projects + Draft comparative analysis based on ... and client specific responses + Collaborate with MHPAEA senior reviewer and Project Manager to conduct follow up calls/emails...a manner consistent with WTW work processes and peer review standards (eg, filing of drafts, deliverables, client and… more
- Kepro (Lombard, IL)
- …leadership and clinical expertise to operations relating to the peer review process, utilization review activities, and other activities requiring ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...in the public sector. Acentra seeks a Psychiatrist Physician Reviewer (Illinois Remote , PRN) to join our… more
- The Cigna Group (Bloomfield, CT)
- …in Utilization Management. Handles moderately complex medical review , utilization review , credentialing/re-credentialing, quality assurance/improvement, ... clinical protocols; and authorizing coverage of services or referring requests for expert clinical review as appropriate. + Be available as an expert advisor… more
- Kepro (Lombard, IL)
- …leadership and clinical expertise to operations relating to the peer review process, utilization review activities, and other activities requiring ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...in the public sector. Acentra seeks an OBGYN Physician Reviewer (PRN, Remote within Illinois) to join… more