Director, Clinical Review - 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. · Clinical Quality Reviews are conducted to determine if the standard of care is rendered and/or if business stan ...

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 ...

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 ...

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 Physician Advisor to join our team at SmarterDx. As a critical role in our expansion into Utilization Management space, you will work closely with Product and Data Science teams to apply real-world physician judgment to the development of clinical logic. · ...

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

We are seeking a licensed Physical Therapist (PT) to support our musculoskeletal care program through virtual patient assessments and clinical chart reviews. · ...

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. ...

The Clinical Director will provide clinical leadership and direction across mental health services. They will ensure services meet ethical and professional standards. This role requires experience in clinical supervision and knowledge of HIPAA confidentiality requirements. · ...

The Clinical Manager leads the charge in ensuring exceptional clinical outcomes for our traveling healthcare professionals and hospital partners. This pivotal role combines clinical expertise with strategic leadership to drive quality, compliance, and operational excellence acros ...

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 ...

We're hiring a Senior UM Review Nurse to join our Utilization Review team at Oscar Health. · You will leverage clinical knowledge, judgment, and established criteria to determine the medical appropriateness of healthcare services. · ...

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 ...

+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 ...

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

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 ...

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 ...