Clinical Reviewer - Henderson, Nevada, , United States

The Clinical Reviewer is responsible for reviewing medical records to identify Medicare Risk Adjusting diagnoses. · Strong clinical understanding and ability to interpret complex medical records · Knowledge of CMS Risk Adjustment models (e.g., HCC, ACO REACH) · ...

The Clinical Reviewer is responsible for reviewing medical records to identify Medicare Risk Adjusting diagnoses and creating clinical summaries. · Conduct detailed medical record reviews. · Create patient condition summaries. · ...

The Clinical Review Coordinator conducts all mandatory case review and quality assurance activities as stipulated by contracts and maintains the required timeliness and accuracy within the review process. · ...

We are seeking a Clinical Pharmacist to review medical necessity and appropriateness of medications for workers' compensation injured employees. · The Clinical Pharmacist will assess the medical appropriateness of proposed medications and work with Amtrust adjusters and nurses to ...

+The Clinical Review Coordinator conducts all mandatory case review and quality assurance activities as stipulated by contracts and maintains the required timeliness and accuracy within the review process. · +Maintains responsibility for assuring an efficient case review process ...

Clinical Review Nurse - Prior Authorization  · Various, NV  · All On-site · Share on · Job Description · Location: Fully Remote – Prefer Candidates reside in NV, but cal reside elsewhere if they have a have NV RN License. · SHIFT: Training schedule is 3 weeks M-Fri 8AM-5PM PSt ti ...

· Full-time · Description · At Commence, we're the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that ...

We are building a World Class Service Center and invite you to join a team of people who are committed to supporting life changing service and providing professional expertise. · The Clinical Documentation Review Specialist plays a crucial role in ensuring the accuracy of clinica ...

People. Passion. Purpose.  · At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients. · We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupt ...

Overall Purpose · The Medical Director, Utilization Management, serves as the physician leader responsible for medical oversight of the Utilization Management (UM) program at P3 Health Partners. This role ensures the quality, safety, effectiveness, and efficiency of utilization r ...

HJ Staffing is urgently seeking a Medical Director of Utilization Management to join a leading Medicare Advantage Health Plan. This physician leader will play a critical role in ensuring the clinical integrity of inpatient and post-acute care reviews, evaluating medical necessity ...

The position requires an active license in one of the following: Social Work, Mental Health Counseling, Marriage & Family Therapy, Counseling, Psychology, or Psychiatry. · Conduct clinical chart reviews (approve/deny daily submissions). · Ensure providers meet SBHSN's clinical co ...

The Director of Medical Management will lead the strategic leadership development and operational oversight of utilization management UM clinical review claims collaboration and medical management functions across multiple delegated managed care health plan contracts and states. ...

This position manages the operations of the Clinical Engineering (CE) Department to provide a regulatory compliant, cost effective program that meets or exceeds the particular quality and financial expectations at one or more acute care facilities in alignment with CommonSpirit H ...

The Research Coordinator will assist an Investigator, Research Associate, or Project Manager in operationalizing tasks associated with implementing a research study. · This includes responsibilities related to recruitment, data collection, · data management and reporting of resul ...

As our Clinical Pharmacist, you'll help our doctors and nurses safely prescribe and dispense medications to help our patients feel better and recover from their illness or injury. · ...

· Where You'll Work · As the only not-for-profit, faith-based healthcare system in the area, Dignity Health Nevada, guided by the Adrian Dominican Sisters' vision for over 70 years, continues to serve the Henderson and Las Vegas communities. The Siena Campus, a 326-bed acute car ...

Seven Hills is a behavioral health hospital serving juveniles, adolescents, adults and geriatric patients. Seven Hills Behavioral Health is located in beautiful, Las Vegas, Nevada. We are seeking a Director of Utilization. We are seeking an individual who is passionate about help ...

The Clinical Pharmacist ensures safe, compliant pharmacy operations by reviewing prescriptions, · monitoring specialty drug therapies, counseling patients, · and collaborating with clinical and operational teams to deliver high-quality specialty care.Verify and dispense prescript ...

We are looking for a RN Concurrent Review at P3 Health Partners in Las Vegas Nevada. · The UM Nurse is responsible for compliance with the Medical Management Program Description of P3 Health Partners regarding Utilization Review inclusive of prior authorization concurrent and ret ...