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Duration: 3+ month’s Contract
Job Description:
* Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices.
Responsi...

Site: The Brigham and Women's Hospital, Inc.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive gr...

Site: The Brigham and Women's Hospital, Inc.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive gr...

Overview
As a Medical Data Reviewer you will be joining the world’s largest & most comprehensive clinical research organisation, powered by healthcare intelligence.
Responsibilities
What you will be doing:
* Ensure study participants meet the written requirements and criteria for Oral Healthcare (OHC) research studies
* Review research protocols and understand study methodology
...

Company Overview
Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.
Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership ...

Who is Comagine Health?
Comagine Health is a national, nonprofit, health care consulting firm. We work collaboratively with patients, providers, payers, and other stakeholders to reimagine, redesign and implement sustainable improvements in the health care system.
As a trusted, neutral party, we work in our communities to address key, complex health, and health care delivery problems. In all...

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-...

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...

HOW YOU'LL MAKE A DIFFERENCE:
The position is responsible for prepping the review forms for the reviewer as well as follow up to ensure timely delivery to our clients. Logs applicable information into the tracking system and updates clients. Professional communication and problem-solving skills are imperative. The position is equally responsible for handling reviewer issues and escalated servic...

LOCATION: Remote -- This is a home based, virtual position that operates Monday – Friday from 8:30am-5:00pm (EST). Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL.
GENERAL STATEMENT OF JOB
The Complex Claims Clinical Reviewer will conduct prepayment and post-payment audits of DRG coding and clinical documentation. The ideal candidate will have an extensive backgro...

Join us today and make a difference in people's lives!
The primary objective of the Field Clinical Manager (FCM) is to be responsible for training health care professionals in the use of pre- and post-market medical devices and associated surgical procedures; for installing and troubleshooting the Company's products in the field; for programming devices and providing technical expertise in the...

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 Description
Welcome to AMN Healthcare: Where Your Career Becomes the Next Big Success Story!
Ever wondered what it takes to build one of the largest and most successful healthcare staffing and total talent solutions companies? It takes trailblazers, innovators, and amazing people like you. At AMN Healthcare, we don’t just offer jobs; we pave the way for incredible care...

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...

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.
MAJOR DUTIES & RESPONSIBILITIES
* Handling Receipt of New Cases:
* Intake new cases and review/verify information and requests. Draft cases by entering inform...

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...