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Job Description
Job Description...
* Performs utilization management reviews in accordance with federal and state regulations
* Maintains compliance with regulatory changes affecting utilization management
* Perform UM reviews (prospective/concurrent/retrospective) for inpatient services according to the NCQA, URAC, CMA & DOH standards and client requirements and/or policies
...

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Physician Clinical Reviewer, MRx - Oncology - REMOTE
Job Description Summary
Key member of the utilization management team, and provides timely medical review of service requests that do not initi...

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Physician Clinical Reviewer- Oncology -REMOTE
Job Description Summary
Key member of the utilization management team, and provides timely medical review of service requests that do not initially me...

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Physician Clinical Reviewer- GI - REMOTE
Job Description Summary
Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet th...

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...

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...

JOB SUMMARY
Responsible for the scheduling and selection of physician reviewers for referrals received within the Dane Street network.
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 for all of us to maintain a positive working environment that promotes client satisfaction and results.
...

Company Overview
The Enlyte Family of Businesses
Mitchell | Genex | Coventry
Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Ou...

Current Employees:
If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review this tip sheet.
The Clinical Documentation Integrity (CDI) Second Level Reviewer performs high-level, complex, second...

Current Employees:
If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review this tip sheet .
The Department of Health Information Management (HIM) has an exciting opportunity for a full-ti...

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About Us
As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care o...

Position Title:
Coding Inpatient Quality Reviewer/Educator (Work From Home)
Department:
HIM Coders
Job Description:
Coding Inpatient Quality Reviewer/Educator
(Work From Home)
OU Medicine - Oklahoma City, OK
General Description:
Performs internal quality assessment reviews on OUMS coders to ensure compliance with national coding guidelines and the OUMS coding policies for comple...

Position Title:
Coding Inpatient Quality Reviewer/Educator (Work From Home)
Department:
HIM Coders
Job Description:
Coding Inpatient Quality Reviewer/Educator
(Work From Home)
OU Medicine - Oklahoma City, OK
General Description:
Performs internal quality assessment reviews on OUMS coders to ensure compliance with national coding guidelines and the OUMS coding policies for comple...

Current Employees:
If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review this tip sheet .
The Clinical Documentation Integrity (CDI) Second Level Reviewer performs high-level, complex, ...

Current Employees:
If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review this tip sheet .
The Department of Information Health Management (HIM) has an exciting opportunity for a full-ti...

BeiGene continues to grow at a rapid pace with challenging and exciting opportunities for experienced professionals. When considering candidates, we look for scientific and business professionals who are highly motivated, collaborative, and most importantly, share our passionate interest in fighting cancer.
General Description:
The Scientific Director or Medical Director, Medical Affairs - A...

Employment Type:
Full timeShift:
Day Shift
Description:
Position Purpose:
Utilizes advanced clinical and coding expertise to direct efforts toward the integrity of clinical documentation through the roles of reviewer, educator and consultant. Facilitates the overall quality, completeness, accuracy and integrity of medical record documentation through extensive record review.
Through extensiv...

Employment Type:
Full time
Shift:
Day Shift
Description:
Position Purpose:
Utilizes advanced clinical and coding expertise to direct efforts toward the integrity of clinical documentation through the roles of reviewer, educator and consultant. Facilitates the overall quality, completeness, accuracy and integrity of medical record documentation through extensive record review.
Through e...

Provides clinical leadership and serves as an internal medical consultant to various divisions and committees to support the development, implementation and monitoring of medical management and quality improvement activities.
Job Description:
Job Responsibilities
* Develop and administer inter-reviewer reliability methodology to ensure medical necessity determinations are consistent with...

Provides clinical leadership and serves as an internal medical consultant to various divisions and committees to support the development, implementation and monitoring of medical management and quality improvement activities.
Job Description:
Job Responsibilities
* Develop and administer inter-reviewer reliability methodology to ensure medical necessity determinations are consistent with...