Clinical Reviewer - Hingham, MA

Job summary The Post-Service Claims Nurse Reviewer is a pivotal role responsible for safeguarding the integrity of our claims process in a post-service pre-payment environment In this position you will leverage your deep clinical expertise and business acumen to ensure all claims ...

The Post-Service Claims Nurse Reviewer is a pivotal role responsible for safeguarding the integrity of our claims process in a post-service, pre-payment environment. · ...

We are seeking an experienced Inpatient RN Utilization Reviewer to independently manage a clinically complex inpatient caseload across multiple care settings, · Registered Nurse with a current, unrestricted state license · ...

A Little About UsZelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumer ...

The Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services. The job requires a strong background in clinical expertise and the ability to work independently and within a team environment. · C ...

At Zelis we Get Stuff Done so let s get it A Little About Us Zelis is modernizing the healthcare financial experience across payers providers and healthcare consumers We serve more than 750 payers including the top five national health plans regional health plans TPAs and million ...

Mass General Brigham relies on a wide range of professionals to advance its mission. As a Clinical Review Specialist, you will facilitate accurate identification of patient medical conditions through comprehensive chart review. You will utilize clinical and coding knowledge to in ...

+Job Summary · Under the general direction of the Director of Risk Capture, the Pre-Visit Clinical Review Specialist (CRS) facilitates the accurate and appropriate identification of patient medical conditions. · +Minimum three (3) - five (5) years' experience required in either c ...

Under the general direction of the Director of Risk Capture, the Pre-Visit Clinical Review Specialist (CRS) facilitates the accurate and appropriate identification of patient medical conditions through comprehensive chart review combined with review of coding output data sources ...

New England Life Care has an opening for a Clinical Review and Coding Supervisor. This is a Work From Home position with occasional travel to branch locations for training. · ...

We enjoy the important work we do every day in service to our members partners colleagues and communities. · Under supervision Utilization Management Supervisor Behavioral Health BH Utilization Management UM Clinician responsible conducting benefit coverage reviews utilization m ...

We are searching for the best talent for Post Market Clinical Review Specialist. The Clinical Review Specialist will serve as clinical expert for the complaint intake review process. · Collaborate with the post market complaint operations and regulatory review teams to ensure cod ...

The Clinical Review Specialist will serve as clinical expert for the complaint intake review process providing clinical rationale linking patient clinical presentation procedural events and product interaction. · * Minimum of 5 years cardiology experience* Demonstrate effective c ...

The Clinical Review Specialist will serve as clinical expert for the complaint intake review process. They will provide clinical rationale linking patient clinical presentation, procedural events, and product interaction. · Minimum of 5 years cardiology experience · Demonstrate e ...

We are searching for the best talent for Post Market Clinical Review SpecialistCollaborate with post market complaint operations · & regulatory review teams to ensure coding guidelines are adhered to. · ...

Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members, as well as monitoring ...

+h2>Job Summary · Clinical Care Reviewer II – Behavioral Health is responsible for processing medical necessity reviews for appropriateness of authorization for behavioral health care services... · Complete prospective concurrent and retrospective review of Behavioral Health serv ...

The Nurse Manager for Utilization Review and Clinical Appeal Management is responsible for overseeing the daily operations of the Utilization Management (UM) and Clinical Appeal teams. · ...

The Nurse Manager oversees daily operations of Utilization Management UM and Clinical Appeal teams ensuring compliance with hospital policies regulatory requirements payer guidelines supporting efficient effective utilization review denial management processes collaborating inter ...

The Nurse Manager for Utilization Review and Clinical Appeal Management oversees daily operations of UM and Appeal teams ensuring compliance with hospital policies regulatory requirements payer guidelines. This role supports efficient effective utilization review denial managemen ...