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Hims & Hers is the leading health and wellness platform, on a mission to help the world feel great through the power of better health. We are redefining healthcare by putting the customer first and delivering access to care that is affordable, accessible, and personal, from diagnosis to treatment to delivery. No two people are the same, so we provide access to personalized care designed for res...

Overview
Empower AI is AI for government. Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions. Our proven Empower AI Platform® provides a practical, sustain...

Your Future Evolves Here
Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.
Evolent employees enjoy work/lif...

Responsibilities:
Under the direction of the supervisor, the Clinical Care Reviewer UM is responsible for completing medical necessity reviews. Using clinical knowledge and experience, the Clinical Care Reviewer UM reviews the provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medi...

The Surgery Clinical Reviewer coordinates, collects, and submits reliable and accurate clinical data to the American College of Surgeon’s National Surgical Quality Improvement Program (NSQIP), through high-quality, complex clinical data interpretation, abstraction, and data validation. This position obtains data via standard and custom reports, analyzes, interpret data's, and identifies opportu...

Optim Health System is seeking (2) full time Certified Coder/Surgical Case Reviewer(s). This is a remote position.
JOB TITLE: Surgical Case Reviewer: Certified Coder
SUPERVISION RECEIVED: Reports directly to Patient Access Director
SUPERVISION EXERCISED: None
TYPICAL WORKING CONDITIONS: Remote
ESSENTIAL DUTIES AND RESPONSIBILITIES: (This list may not include all of the duties assigned.)
...

Position Purpose:
Acts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.
Education/Experience:
...

LOCATION: Remote – this is a home based, virtual position. This person must live in North Carolina or within 40 miles of the North Carolina border.
GENERAL STATEMENT OF JOB
The Psychologist Peer Reviewer is part of the Utilization Management Team who conducts Peer Reviews and fulfills multiple other functions involved with service reviews and appeals, ensuring that Vaya Health (Vaya) adher...

Job Category:
Revenue Cycle
Work Shift/Schedule:
Varies
Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.
About the Role:
Job Summary
The Coding Quality Reviewer II is responsible for performing quality analysis of coded medical records, documenting the analysis, summarizing the metrics and reporting quality statistics to management. ...

Job Category:
Revenue Cycle
Work Shift/Schedule:
8 Hr Morning - Afternoon
Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.
About the Role:
Job Summary
The Coding Quality Reviewer II is responsible for performing quality analysis of coded medical records, documenting the analysis, summarizing the metrics and reporting quality statisti...

Company Overview
At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing cli...

Company Overview
At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing cli...

The Data Reviewer Specialist acts as a contributing specialist for studies, with the ability to carry out aspects of data review, expediting audit responses, and reporting (data reviewing with minimal guidance) through report finalization. The Data Reviewer Specialist has excellent organizational skills and utilizes a strong base in regulatory policy to assess data review and reporting and main...

JOB SUMMARY
The QA Specialist plays an integral role in the review process as they are responsible for communicating with the customer, reviewer, and management to ensure a completed report is delivered by the customer requested due date.
The QA Specialist is responsible for the timely completion and overall completeness of a reviewer report. Completeness is determined by customer requirements,...

JOB SUMMARY
The Quality Analyst is responsible for managing the various aspects of the medical file review process. They will review the completed referral to ensure client questions have been addressed appropriately and review the completed report for accuracy. Ensuring client and department standards have been met.
Dane Street's success relies on individual and team contributions every day. W...

JOB SUMMARY
The Customer Service Representative is responsible for receipt of new cases and ensuring proper system drafting and setup. The CSR also is responsible for taking direction and facilitating the case assignment/scheduling process.
Dane Street's success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility...