beBeeClinicalReview Jobs in United States

The ideal candidate will possess a valid nursing license and have experience as a pre-authorization, utilization review nurse or clinical team lead/supervisor. · ...

Job Overview · We are seeking a seasoned medical professional to join our team as a Clinical Review Specialist. · ...

Clinical Review Nurse Job Description · We are seeking a skilled Clinical Review Nurse to join our team. As a Clinical Review Nurse, you will play a crucial role in reviewing healthcare claims and making determinations regarding the validity of claims and levels of payment. · ...

Job Opportunity · A career in clinical data review offers a chance to impact the integrity of clinical trials. · Key Responsibilities · Critical manual examination of collected data; · Creation and maintenance of guidelines for therapeutic areas; · ...

Job Description · Clinical Review Clinician Opportunity · , · Key Responsibilities: · >, <ul style= ...

Key Clinical Responsibilities · Clinical Review Nurses play a vital role in supporting marketplace expansion for various regions. They are responsible for reviewing and processing prior authorization requests using established policies, guidelines, and clinical knowledge. · Their ...

This is a dynamic and fast-paced Clinical Review Clinician role. · Job Opportunity · We are seeking an experienced professional to join our team as a Clinical Review Clinician. This position will be responsible for assessing services provided to members, ensuring they meet the ne ...

Job Title: Clinical Review Nurse - Medicaid Outlier Specialist · About the Job · This role involves comprehensive reviews of clinical data to ensure accurate and appropriate processes. The ideal candidate will possess in-depth knowledge of utilization review programs and be able ...

Clinical Review Clinician · This role involves performing detailed medical audits and analyzing healthcare claims with minimal supervision. · Must possess a current RN license or LPN qualification. · Prioritize clinical experience as essential for this position. · ...

Medical Claims Examiner Job Description · This position requires a clinical background, experience in medical claims review and utilization management. The Medical Claims Examiner will be responsible for reviewing retrospective medical claim reviews, validating member medical rec ...

You must interact with providers professionally and have strong communication skills. Additionally, excellent analytical skills are necessary to interpret data effectively. · ...

Job Summary: · Clinical Review Specialist · This position involves assessing services for optimum outcomes, cost-effectiveness and compliance with regulations. · 's primary focus is on the implementation of clinical guidelines in accordance with state/federal regulations. The rol ...

Key Responsibilities: · Evaluate the medical necessity of claims to ensure accurate processing. · Utilize advanced clinical knowledge to assess the appropriateness of services provided. · Hello: Assist in complex claim reviews, making informed recommendations based on clinical ex ...

Clinical Review Nurse Position · A government agency in Arizona is seeking a skilled Clinical Review Nurse to oversee claim reviews and ensure compliance with healthcare regulations. · Requires a current Arizona RN license and knowledge of various medical coding standards. · The ...

Clinical Reviewer Position · In this challenging role, you will be responsible for reviewing and processing independent review requests from external agencies. · ...

Perform timely initial and continued stay reviews using established guidelines (MCG, CMS criteria). · Document clinical findings and level of care determinations in the EMR and UR tracking systems. · ...

Job Title: Clinical Review Nurse Specialist Clinical Healthcare Services Analysis · The Clinical Review Nurse Specialist is responsible for evaluating medical services to ensure accuracy and fairness of healthcare payments. This position involves analyzing multiple types of medic ...

Job Title: Clinical Review Coordinator · Job Summary: · The Department of Case Management at SUNY Downstate Health Sciences University is seeking a full-time TH Utilization Review & Quality Assurance Senior Coordinator / Utilization Review Nurse. · ...

Clinical Review Nurse I · We are seeking a skilled Clinical Review Nurse I to review and make medical determinations regarding claims. · Assesses the necessity and reasonableness of items supplied through medical policy as per company guidelines. · ...

About the Role · This is an exciting opportunity for an experienced nurse with strong clinical knowledge and analytical skills to contribute to our review process. · In this role, you will be responsible for conducting thorough reviews of medical claims and appeals, ensuring alig ...