1099-PRN Physician Opportunity for Utilization Review - Remote

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 ...

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 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 ...

This position is responsible for assisting with the coordination of the 340B Drug Pricing Program for all qualified entities throughout the WVU Medicine Health System. · ...

The Prior Authorization Clinician is responsible for reviewing all proposed hospitalization services for medical necessity to ensure members receive appropriate care. · We are committed to diversity and inclusion of staff among our employees. ...

We are looking for a Behavioral Health Utilization Review Specialist to join our team. This is a full-time, non-exempt position reporting to a UR Team Lead. · Evaluate patient medical records to determine the necessity and appropriateness of services provided. · ...

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 ...

+Job summary · Quality professional who works under supervision and brings ideas to daily responsibilities. · +ResponsibilitiesEffectively work in a fast-paced environment utilizing the Agile methodology. · ...

The physician reviewer performs medical review activities pertaining to delegated pediatric services including medical review of complex controversial or experimental medical services. · ...

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

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

We're looking for a certified pharmacy technician experienced in managed care specifically Part D/MAPD and who has had additional PBM collaboration relative to the administration of Part D and Part B pharmacy claims. · At Devoted Health, we're dedicated to providing personalized, ...

The Resource Manager supports Avertium's professional services delivery by aligning consulting resources with sales pipeline demand, · active projects, and forecasted work.Maintain a centralized view of consultant availability,capacity,and project assignments across multiple sche ...

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 privileged and humbled to serve an amazing group of clients and members. As our relationships flourish and our business expands, we find ourselves in the fortunate position of adding a Medical Director to our incredible team. · Serves as a key clinical resource for staff. ...

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

Hireology's technology empowers businesses to build great teams. · ...

Join us to be part of a forward-thinking people-centered company where your ideas and contributions truly matter. · ...

· About Us · We are Emerus, the leader in small-format hospitals. We partner with respected and like-minded health systems who share our mission: To provide the care patients need, in the neighborhoods they live, by teams they trust. Our growing number of amazing partners includ ...

We seek to create an environment that cultivates your professional development and personal growth as we believe your success is our success. · Perform Peer-to-Peer case discussions with payer medical directors · Utilize clinical expertise to identify the salient points within a ...

We're on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We help physicians focus more on patient care and less on paperwork through smarter technology, purpose-built tools, and a team-based model of care. · Conducting Initial ...