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JOB TITLE (#25193 ) : Psychiatrist / VA Reviewer - Remote
Minimum of 5 years active clinical practice within the specialty.
Greenlife Healthcare Staffing is currently seeking a Psychiatrist - VA Reviewer to fill an opening with a Non-profit organization
Requirements of the Psychiatrist / VA Reviewer :
* Hold a current, non-restricted license in a U.S. state or territory;
...

Schedules Physician Clinical Review (PCR) utilization management reviews (including peer to peer telephone discussions and provider outreach discussions) for Magellan Rx Management clients for medical pharmacy/specialty, PBM, MRX Navigate, and Medicare Part D areas of business. Performs follow-up to ensure reviews occur as scheduled and written reports are generated by Physician Clinical Review...

Schedules Physician Clinical Review (PCR) utilization management reviews (including peer to peer telephone discussions and provider outreach discussions) for Magellan Rx Management clients for medical pharmacy/specialty, PBM, MRX Navigate, and Medicare Part D areas of business. Performs follow-up to ensure reviews occur as scheduled and written reports are generated by Physician Clinical Review...

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 ...

JOB TITLE (# 25021 ): Mental and Behavioral Health PA / 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 a Mental and Behavioral Health Physician Assistant - VA Reviewer to fill an opening with a Non-profit organization
Requirements of the Mental and Behavioral He...

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
...

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,...

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
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.
In addition to the duties of the QA Specialist, the Clinical QA Specialist is also responsible for ensuring that the clinical content is accurate and adequate...

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...

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...

If you are a current employee at Sarah Bush Lincoln Hospital System, Do NOT complete this application. Please go to the internal career site to complete your application!
Clinical Documentation Specialist (Registered Nurse)
Job Description
Clinical Documentation Specialists provide concurrent review of the clinical documentation in the medical records. Provides education to physicians and mid-...

The Inpatient Coding Quality Reviewer will be responsible for reviewing inpatient coded cases for coding completeness and accuracy. This person will identify potential coding and DRG errors, researches appropriate guidelines to support recommended changes, and communicates the changes to the coder involved on a timely basis. The Reviewer provides expert coding advice to coding staff and relays...

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 Concurrent Quality Reviewer of our hospital reviews documentation in the electronic medical...

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 Concurrent Quality Reviewer of our hospital reviews documentation in the electronic medical recor...

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 Concurrent Quality Reviewer of our hospital reviews documentation in the electronic medical...

Company :
Highmark Inc.
Job Description :
JOB SUMMARY
This job provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan’s state and federal multiple drug benefit design offerings. The incumbent responds to physician and pharmacy network provider inq...

The Inpatient Coding Quality Reviewer will be responsible for reviewing inpatient coded cases for coding completeness and accuracy. This person will identify potential coding and DRG errors, researches appropriate guidelines to support recommended changes, and communicates the changes to the coder involved on a timely basis. The Reviewer provides expert coding advice to coding staff and re...

This is a remote/work from position, candidates must be licensed and reside in Hawaii.
Under general supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or outpatient care settings. Collects and analyzes utilization data. Assists with discharge planning and care coo...