Medical Reviewer II - Nashville

We are part of the national landscape for more than seven decades with our roots firmly embedded in the South Carolina community and we deliver outstanding service to our customers. · Oversees operations of assigned areas. Coordinates tactical team activities. · Ensures area revi ...

Summary · Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical c ...

We are adding five new staff to our Medicare Part A Medical Review team focusing on Prior Authorizations. This position will lead a team of four to ten Medical Reviewers.We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining ...

We are seeking a Medical Review Supervisor to lead our Medicare Part A Medical Review team focusing on Prior Authorizations. · This position will supervise four to ten medical reviewers and ensure appropriate levels of healthcare services are provided. · Manages day-to-day activi ...

This position acts as Team Lead helping to ensure appropriate levels of healthcare services are provided. The Senior Medical Reviewer is responsible for conducting second-level medical reviews of appeals and preparing comprehensive ALJ (Administrative Law Judge) position papers f ...

This role requires a strong understanding of medical records review and the medical appeals process. Ensures appropriate levels of healthcare services are provided. · Conducts comprehensive reviews of medical documentation and applies advanced knowledge of Medicare Local Coverage ...

Summary · Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical c ...

· We are seeking a skilled and board-certified Ophthalmologist to join our team in TN for a Medical Record Review Case. · Key Responsibilities: · Review Medical Records: Thoroughly review and analyze patient medical documents related to the case. · Address Clinical Questions: Re ...

We are looking for a dynamic and enthusiastic team member to join us to save lives Our mission at DCIDS is to save lives through organ and tissue donation, and we want professionals on our team that will embrace this important work This position will perform a medical record revi ...

Performs claim documentation review verifies policy coverage assesses policy application validity communicates with healthcare providers policyholders and beneficiaries to ensure accurate and timely handling of the medical review process. · ...

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safe ...

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safe ...

Dane Street is expanding our physician panel We are seeking a skilled and board-certified Family Practice physician to join our team for Independent Medical Record Reviews. This is a fully remote opportunity offering flexible scheduling, allowing you to accept or decline cases ba ...

Dane Street is expanding our physician panel We are seeking a skilled and board-certified (Specialty) to join our team for Independent Medical Record Reviews. This is a fully remote opportunity offering flexible scheduling, allowing you to accept or decline cases based on your av ...

Dane Street, a nationally recognized Independent Review Organization (IRO), is expanding its panel of Physician Reviewers. We are currently seeking Board-Certified Physical Medicine and Rehabilitation providers with an active New York medical license and Workers Compensation Boar ...

Dane Street is expanding our physician panel Due to added clients and increased volume, we have an urgent need for board-certified, licensed physicians to support Disability Peer Reviews as a Designated Medical Officer. · Currently, we are seeking the following specialties licens ...

Dane Street is expanding our physician panel Due to added clients and increased volume, we have an urgent need for board-certified Physicians to support Disability Peer Reviews. · JOB SUMMARY · Physician Reviewer/Advisor utilizes clinical expertise to review medical records provi ...

Physician / Surgery - Orthopedics Opportunity · We are seeking a skilled and experienced Board Certified Orthopedic Surgeon to join our team as an Associate Medical Director. This is a full-time, permanent position with a predictable work schedule. · - Provide timely expert medic ...

Physician / Gastroenterology · An exciting opportunity is available for a skilled Gastroenterologist to join our team as an Associate Medical Director at eviCore Healthcare in Tennessee. · Provides timely and expert medical review for services that do not meet utilization review ...

Dane Street is seeking experienced · Board-Certified Orthopedic Surgeon · to join our growing team of expert clinical reviewers. In this role, you will apply your expertise to conduct comprehensive reviews of clinical cases and provide objective, evidence-based medical opinions. ...