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Medical Data Reviewer
ICON plc is a world-leading healthcare intelligence and clinical research organization. We’re proud to foster an inclusive environment driving innovation and excellence, and we welcome you to join us on our mission to shape the future of clinical development
Senior Medical Data Reviewer
Homebased
Key Responsibilities:
Collaborate closely with Medical Leads and Clin...

Grow Healthy
If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a ...

Grow Healthy
If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a ...

A vital role of the CMO Administration team, the Medical Peer Reviewer plays a critical role in consulting on medical necessity in the context of utilization management and ensuring adherence to internal Healthfirst and external regulations.
Duties/Responsibilities:
* The Medical Peer Reviewer will assess/review requests for authorization, and claims payment, based on medical records and ...

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...

JOB TITLE (# 25023 ): Emergency NP / VA Reviewer - Remote
Minimum of 5 years active clinical practice within the specialty and 2 years of recent experience
Greenlife Healthcare Staffing is currently seeking an Emergency Nurse Practitioner - VA Reviewer to fill an opening with a Non-profit organization
Requirements of the Emergency NP / VA Reviewer :
* Must hold a current, non-...

JOB SUMMARY
The Credentialing Assistant is responsible for screening reviewers for required credentialing and background information, including professional sanctions and criminal background information. The position requires coordination between multiple departments at Dane Street to provide support relating to the information, data, and standards involved in reviewer credentialing.
Dane Stree...

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.)
...

Overview
Lead Quality Reviewer
The Lead Quality Reviewer serves as the individual coordinating training for new client Electronic Medical Record (EMR), Quality Reviewers, and assisting with claims eligibility inquiries. This position compiles monthly 340B compliance reviews for distribution, as well as completes routine reviews of prescriptions to determine if established 340B eligibility has...

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:
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...

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. ...

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 Category:
Administrative & Clerical
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 I is responsible for performing quality analysis of coded medical records, documentation of the analysis, summarizing the metrics and reporting quality statistics...