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Northwell
Overview
Dispenses medications and pharmaceutical products while verifying prescriptions for accuracy and clinical appropriateness. Provides patient counseling and coordinates with providers and couriers to ensure timely delivery of prescriptions.
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Compensation
$105,400 - $183,000 / YEAR
Posted
4 days ago
OSF HealthCare
The specialist evaluates patient care and admission status against objective criteria to ensure medical necessity. They identify and resolve utilization issues regarding the over or under-utilization of hospital services.
Salary not listed
Luminis Health
Conducts concurrent and retrospective chart reviews to assess clinical, financial, and resource utilization. Collaborates with care coordinators and providers to reduce avoidable delays, manage denials, and optimize patient outcomes.
$34 - $55 / HOUR
Centene Corporation
Conducts clinical reviews and prior authorizations for mental health and substance abuse services to ensure medical appropriateness. Monitors inpatient stays and collaborates with providers and medical directors to optimize care quality and efficiency.
$27 - $49 / HOUR
St. Luke's University Health Network
The RN Clinical Review Appeals Specialist conducts retrospective reviews of patient medical records and claims data to ensure accurate coding and DRG assignment. They develop appeal arguments and facilitate communication with various stakeholders to resolve documentation and coding issues.
7 days ago
Prime Therapeutics
This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, often interacting with requesting physicians and providers. Responsibilities include discussing determinations, providing clinical rationale for appeals, and ensuring documentation accuracy according to established guidelines.
$91 - $154 / HOUR
8 days ago
This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, requiring interaction with physicians and providers to discuss determinations and provide clinical rationale for appeals. The reviewer also assists in maintaining consistency by utilizing clinical review guidelines and participating in training and research activities related to utilization management.
This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, often interacting with physicians and management staff. Responsibilities include discussing determinations with requesting providers and providing clinical rationale for standard and expedited appeals.
The Physician Clinical Reviewer provides timely medical review of service requests that do not meet initial medical necessity guidelines, routinely interacting with physicians and staff. Responsibilities include discussing determinations with requesting providers, providing clinical rationale for appeals, and ensuring consistency using medical review guidelines.
The Physician Clinical Reviewer conducts timely medical reviews of service requests that do not meet initial necessity guidelines. They also provide clinical rationale for appeals and act as a resource for the utilization management team.
This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, requiring routine interaction with physicians and management staff. Responsibilities include discussing determinations with requesting providers within regulatory timeframes and providing clinical rationale for standard and expedited appeals.
The Physician Clinical Reviewer provides timely medical review of service requests that do not initially meet medical necessity guidelines, interacting with providers and staff as needed. Responsibilities include reviewing complex cases, discussing determinations with requesting physicians, providing clinical rationale for appeals, and ensuring compliance with various guidelines and policies.
Acentra Health, LLC
The Clinical Reviewer is responsible for reviewing medical records to ensure alignment with clinical criteria, guidelines, and contractual requirements. They also serve as a liaison to healthcare providers and participate in quality monitoring and performance improvement initiatives.
14 days ago
MRIoA
The Physician Advisor will apply clinical expertise to evaluate medical service requests, interpret benefit language and medical policies, and make sound coverage determinations. Core duties include performing clinical coverage reviews, documenting outcomes according to standards, and participating in peer-to-peer discussions with treating providers.
15 days ago
The role involves applying clinical expertise to evaluate medical service requests, interpret benefit language and medical policies, and make sound coverage determinations based on established guidelines. Responsibilities also include documenting review outcomes and engaging in peer-to-peer discussions with treating providers when necessary.
University Health
The nurse coordinates and plans all aspects of care for scheduled surgical patients in collaboration with anesthesia providers and multidisciplinary teams. Responsibilities include conducting clinical assessments, reviewing medical records, and providing essential pre-surgical patient education.
17 days ago
UNITAS
The pharmacist is responsible for processing and documenting Utilization Management requests, including prior authorizations and formulary exceptions. They provide clinical evaluations and consult with healthcare providers regarding product coverage issues.
$55 - $60 / HOUR
21 days ago
Southcoast Health System, Inc.
Perform professional services related to the clinical review of patient drug therapy. Provide immediate direction and supervision of assigned personnel while adhering to state and federal regulations.
$55 - $70 / HOUR
Sutter Health
Provides crisis intervention, referrals, and complex discharge planning for patients and families across all age groups. Acts as a liaison to community resources and collaborates with the healthcare team to ensure cost-effective, high-quality care.
$47 - $63 / HOUR
Neuropsychiatric Hospitals
The coordinator manages patient services across the continuum of care by promoting effective utilization and monitoring health resources. Key duties include performing precertifications, concurrent clinical reviews, and collaborating with multidisciplinary teams to resolve appeals and denials.
22 days ago
