Medical Reviewer II - Philadelphia - CGS Administrators

At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in ...

This Medical Reviewer RN III performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. · Perform medical claim reviews for one or more of the following: claims for medically complex ...

At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in ...

The Medical Consult and Review Physician position resides in the Value & Implementation (V&I) organization, which includes Global Medical and Scientific Affairs as well as Outcomes Research. · ...

The Principal Scientist Medical Consult Review Physician position provides clinical expertise and advice to internal stakeholders as well as medical training curricula for products addressing basic advanced training needs of V&I personnel. · ...

The Principal Scientist will provide clinical expertise and advice to internal stakeholders and serve as a member of several cross-functional teams.Ensure clinical relevance and medical accuracy of data/information in promotional materials. · Serve as a member of the Promotion Re ...

This role resides in the Value & Implementation organization and requires clinical expertise to provide advice to internal stakeholders. · ...

We are seeking an experienced HEDIS Data Reviewer to work at our client's company in Philadelphia. · ...

Certified Pharmacy Technician · The Certified Pharmacy Technician supports the Direct Ship Team within Care Management & Coordination by reviewing clinical documentation and authorization requests to determine medical necessity for pharmacy services. This role applies established ...

Job Title: Utilization Management RN (Precertification) · Location: Remote (Candidates must reside in PA, NJ, or DE) · Overview · We are seeking an experienced Utilization Management RN to join a Precertification team responsible for reviewing clinical documentation and determini ...

The HEDIS Data Reviewer is responsible for performing medical record abstraction and overread in support of Quality reporting. · Coordination of the medical records identification process. · Performing structured auditing abstraction criteria to medical records. · ...

The HEDIS Data Reviewer is responsible for performing medical record abstraction and overread in support of Quality reporting (annual Healthcare Effectiveness Data and Information Set (HEDIS) and State EQRO). · Coordination of the medical records identification process, collectio ...

HEDIS Data Reviewer job opportunity in Philadelphia involves medical record abstraction and overread for HEDIS and State Quality reporting. · Perform medical record abstraction and overread for HEDIS and State Quality reporting. · ...

SHIFT: · Evening (United States of America) · Seeking Breakthrough Makers · Children's Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and ...

The HEDIS Data Reviewer is responsible for performing medical record abstraction and overread in support of Quality reporting. · ...

The HEDIS Data Reviewer is responsible for performing medical record abstraction and overread in support of Quality reporting (annual Healthcare Effectiveness Data and Information Set (HEDIS) and State EQRO)No information available ...

Dane Street is expanding our physician panel We are seeking a skilled and board-certified Diagnostic Radiologist 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 ...

Dane Street is expanding our physician panel We are seeking a skilled and board-certified Neurological Surgeon 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 o ...

Utilization Management RN (Part-Time) · We are seeking an experienced Utilization Management RN to join our team in a part-time capacity. · Schedule · Every other weekend (Saturday & Sunday) · Approximately 30 hours per month · Training requirement: Must be available Monday–Frida ...

The HEDIS Data Reviewer performs medical record abstraction and overread in support of Quality reporting (annual Healthcare Effectiveness Data and Information Set (HEDIS) and State EQRO). ...

HEDIS Data Reviewer · The HEDIS Data Reviewer will support HEDIS and State EQRO quality reporting through accurate medical record abstraction auditing chart review. · This role requires strong knowledge of HEDIS technical specifications audit processes clinical documentation inte ...