Clinical Reviewer - Remote

The Clinical Quality Reviewer is a critical member of the Foundation Company's Quality Department to ensure and continuously improve the services provided to clients. This position is responsible for performing on-going assessments of quality of services and systems and for compl ...

About MMRO is an established URAC-accredited Independent Review Organization (IRO) that provides objective evidence-based medical peer reviews nationwide. We are currently seeking Board-Certified Orthopedic Surgery Physicians to join our network of sub-contracted Physician Review ...

The Physician Advisor will play a critical role in SmarterDx's expansion into the Utilization Management space. This role will work closely with Product and Data Science teams to apply real-world physician judgment to the development of clinical logic, · Review and refine AI-gene ...

· Supervising Physician – Urgent Care (Georgia) · Position Title: Supervising Physician – UrgenCare · Location: Georgia (Remote supervision with availability during clinic hours) · Specialty Preferred: Urgent Care, Emergency Medicine, Family Practice, or Internal Medicine · Posi ...

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 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 ...

Midi is seeking a Clinical Director to lead care delivery across a defined pod of clinicians and assigned care delivery pillars. This is a hybrid role combining senior clinical leadership and operational ownership with direct patient care. · ...

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. · ...

The Clinical Documentation Integrity Specialist will review inpatient medical records for completeness and accuracy. ...

We're hiring a Physician Reviewer to join our Utilization Management team. Determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. · You are also eligible for employee benefits ...

The Clinical Auditor I performs detailed medical record audit review and analysis of the health plan's outpatient, professional and ancillary claims to ensure that all reimbursement to the provider is paid accurately and ensuring adherence to regulations, internal policies and be ...

· Description · Position at Healthmap Solutions · Company Background · Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data reso ...

We are looking for a Bilingual Clinical Pharmacist to join a strong team of clinicians and help optimize patient outcomes. · Evaluate and assess patient data in Arine's software platform. · Complete medication reviews and counseling appointments. · Staff various clinical shifts a ...

This position is responsible for obtaining authorizations for elective infusions and injections to financially clear patients and ensure reimbursement for the organization. ...

We're excited you're considering an opportunity with us to join our Peak Health team at WVU Medicine as a Benefit Configuration Analyst contributing to the foundation for an innovative new health plan. · This role will review implement and test new plan designs update existing be ...

+Job summary · We are seeking an experienced Senior Medical Writer to lead, plan, author and manage high-quality clinical and regulatory documents for Candel's oncology programs.++Serve as an author for BLA clinical modules. · Author and update Clinical Study Reports. · ++Bachelo ...

About the role · We're seeking an energetic, detail-oriented, proactive, and hands-on Clinical Trial Manager who thrives in a fast-paced environment. In this role, you'll support the day-to-day clinical operations oversight for clinical trials as assigned. The ideal candidate sho ...

We are seeking a Clinical Sales Representative to join our dynamic and collaborative team. The successful candidate will report to the Clinical Sales Manager and be responsible for delivering an excellent customer experience for all Galaxy customers within their territory. · The ...

Partner with our Clinical Pharmacy and Operations teams to assist in outreach, coordination, and follow-up to ensure best-in-class care for our members. The Pharmacy Care Coordinator will also establish and maintain relationships with providers, medical directors, and network con ...

We're hiring a Utilization Review Nurse to join our Utilization Review team. You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. · Complete medical necessity reviews and level of care reviews for requested ser ...

About Eyebot · Eyebot is an outcome-focused technology company on a mission to make vision care accessible to everyone, equally. Headquartered in Boston's North End and backed by top investors and the National Science Foundation, our vision test kiosk is reshaping how vision care ...