Clinical Program Manager – CMS Medical Review - United States - Remote

We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team. This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. · Review medically complex claims, pre-authorization reque ...

We transform challenges into opportunities with expert program management,cutting-edge technology,and innovative consulting solutions. · Performs medical claim reviews for one or more of the following:claims for medically complex services,services that require preauthorization/pr ...

The Medical Director serves as the senior clinical authority for the CMS Review and Validation Contractor (RVC) program. This role provides leadership and oversight for all medical review functions, ensuring compliance, clinical accuracy, · and alignment with Medicare coverage an ...

We are seeking experienced physicians to conduct independent case reviews for the Department of Veterans Affairs (VA). This role involves evaluating medical cases to assess quality of care, adherence to standards, and opportunities for improvement. · Conduct objective medical cas ...

The RN Senior Medical Reviewer provides advanced medical review expertise and supports oversight of the medical review process. · ...

We are looking for freelance medical reviewers who will assess and improve the medical accuracy of our content. · ...

The RN Senior Medical Reviewer provides advanced medical review expertise and supports oversight of the medical review process, focusing on complex services and quality assurance. · ...

The healthcare industry still relies on faxes and phone tag to coordinate critical care for patients at home. We think patients and the clinicians who serve them deserve better than a system stuck in 1995. · ...

+We are building a new kind of biotech company that maintains its roots as a science-based start-up and pushes our commitment to innovate across all corners of our business. · +Lead an indication sub-team of Medical Reviewers within the US Medical Review Community. · Provide solu ...

We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team. · Review medically complex claims and pre-authorization requests. · Evaluate medical necessity and appropriateness for coverage and reimbursement. · Provide clear rationales for service approvals or ...

The Medical Review (MR) Manager oversees all medical review activities and quality assurance functions for the CMS Review and Validation Contractor (RVC) program. · Minimum of 5 years of medical review experience. · ...

MMRO is an established URAC-accredited Independent Review Organization that provides objective medical peer reviews nationwide. · Conduct comprehensive medical chart reviews with honesty and integrity. · Produce determinations that are clear and well-supported by evidence. · ...

We're excited you're considering an opportunity with us. Responsible for working in collaboration with the Medical Director on driving the decrease in care variance, to ensure timely discharges, and to refer members to other plan resources to meet their care conditions. · ...

This position will report to the Claims Manager, playing a unique and important role in our mission to change healthcare for the better. Experience in the healthcare industry and critical thinking skills will help the organization build an effective and efficient claims team. · T ...

We are seeking a motivated Regulatory Affairs Consultant – Advertising & Promotion to join Parexel and work as a trusted partner within a major client engagement. · Key Responsibilities · Review and approve advertising and promotional materials. · Provide regulatory guidance to c ...

The Medical & Scientific Publications Manager/Associate is an integral part of the medical team accountable for executing the medical communication plan for products and pipeline assets. · ...

Clover is reinventing health insurance by combining the power of data with human empathy to keep our members healthier. · ...

The Director Medical Information will lead and manage planning and execution of Medical Information activities and materials for Cristcots portfolio. This critical role will lead creation of standard response documents to requests for medical information establish and manage stan ...

The Professional Coder Specialist III reviews surgical documentation to assign accurate ICD-10 codes. Complies with national coding guidelines ensuring procedures are coded accurately.Reviews all surgical documentation for accuracy. · Contacts & Collaborates with personnel for do ...

To ensure accurate and appropriate gathering of information into the coding classification systems to meet departmental hospital anbd outside agency requirements. · ...