surgical clinical reviewer - Richardson, TX

The Surgical Clinical Reviewer's chief responsibility is to collect and submit reliable data to the ACS NSQIP. · The SCR works closely with the members of the Department of Surgery to identify opportunities for clinical quality improvement. · Participation in quality programs in ...

The Clinical Review Pharmacist has the responsibility of reviewing the medical necessity, appropriateness, and quality in the appropriate setting for workers' compensation injured employee as it pertains to their medications. · 3+ year of experience in pharmacy clinical care · Ph ...

+The Clinical Review Coordinator works closely with all departments to research and provide accurate and timely clinical review on complex, patient cases to ensure that approval is secured and to mitigate risk of technical and clinical denials. · +Completes prior authorization re ...

Soleo Health is seeking a Clinical Review Coordinator to support our Specialty Infusion Pharmacy and work Remotely (USA). The position involves researching and providing accurate and timely clinical review on complex patient cases to ensure approval and mitigate risk of technical ...

This position allows you to telecommute from anywhere in the U.S., working on challenging tasks. · You'll enjoy flexibility while taking on some tough challenges. · At UnitedHealthcare,we're simplifying the health care experience,creating healthier communities,and removing barrie ...

Soleo Health is seeking a Clinical Review Coordinator to support their Specialty Infusion Pharmacy working Remotely (USA) · Completes prior authorization reviews in a timely manner through their clinical expertise evaluating patient clinicals and payer clinical criteria to determ ...

This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. · At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality ...

+Job summary · At UnitedHealthcare,+we're+making+the+healthcare+experience+simpler.+We're+helping+millions++of people... ...

Se busca especialista en revisión de denegaciones clínicas para trabajar desde casa. · Triage incoming inventory · validating appeal criteria is met in compliance with departmental policies and procedures · Review Medicare Recovery Audit Contractor (RAC) recoupment requests and p ...

We are seeking a Clinical Denials Coding Review Specialist for our team to ensure that we continue to provide all patients with high quality, efficient care. · Triage incoming inventory, validating appeal criteria is met in compliance with departmental policies and procedures · R ...

We are seeking an experienced board-certified Physician Reviewer to evaluate clinical service requests within our organization. · Review and adjudicate clinical service requests using clinical expertise. · Collaborate with case managers to support anticipatory case management. · ...

This position is responsible for ensuring accurate and timely clinical review of behavioral health cases for medical necessity including assisting members on the telephone, reviewing medical records, · Reviewing cases which involves contract interpretation of behavioral health di ...

We're seeking a detail-oriented and experienced Registered Nurse (RN) to join our Medical Review team. · In this role, you will use medically accepted clinical criteria to assess the medical necessity and appropriateness of treatment plans. · ...

+ Supervise clinical staff involved in behavioral health clinical operations such as Utilization Management and/or Disease Management. · + Implement processes and monitor results. · + Ensure delivery of effective customer service.+ ...

Join Viva Pediatrics - Where Passion Meets PurposeVIVA Pediatrics is a home health services company with a specialty in private duty nursing, therapy and skilled nursing visits for infants and children. · We are committed to providing each patient with an exceptional level of car ...

The Pediatric Home Care Clinical Supervisor oversees the delivery of high-quality, compassionate nursing and rehabilitative care to pediatric patients receiving services in the home setting. · This role provides clinical leadership, ensures regulatory compliance, supports field s ...

Give back to our nation's Veterans Practitioners will be in a clinic setting to provide one-time Physical Health Assessments to active-duty military personnel & Compensation and Pension evaluations to Veterans which includes reviewing the PHA form Functional Capacity Certificate ...

Pediatric RN Case Manager at Viva Pediatrics - Where Passion Meets Purpose. · ...

We are seeking a Clinical Research Manager to lead our clinical research team. The successful candidate will have experience in clinical research management, excellent leadership skills, and strong analytical abilities. · ...

We are seeking an experienced board-certified Physician Reviewer to evaluate clinical service requests from members and providers within our organization. · Review and adjudicate clinical service requests using clinical expertise. · Collaborate with case managers to support antic ...