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Elevance Health
Overview
Collaborate with healthcare providers and consumers to drive personalized health management and improve outcomes for members with complex needs. Assess medical necessity for admissions and services while developing and monitoring individualized care plans.
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Compensation
Salary not listed
Posted
8 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
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.
13 days ago
Greenlife Healthcare Staffing
Conduct clinical reviews and abstractions of medical records related to maternal deaths and adverse outpatient surgical events. Develop narrative summaries for the NYS Department of Health and track case status using Excel and other databases.
$60 / HOUR
24 days ago
Community HealthWorks
The Licensed Clinical Reviewer performs quality assurance and clinical documentation reviews for CalAIM programming to ensure alignment with billing standards and program requirements. This role involves providing feedback to staff, determining client acuity, and supporting audit readiness.
$55 - $75 / HOUR
1 month ago
Conduct administrative and process-based reviews of medical records for Applied Behavior Analysis (ABA) services to ensure compliance and medical appropriateness. Act as a liaison for providers and collaborate with supervisors to monitor quality and improve review processes.
University of Mississippi Medical Center
The RN-Scr Data Abstractor is responsible for collecting and submitting reliable data to the NSQIP, identifying surgical patients, and reporting data for quality improvement. The role involves collaboration with the Surgery department and educational resource development for internal and external audiences.
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 discussing determinations with requesting physicians, providing clinical rationale for appeals, and ensuring documentation accuracy according to established guidelines.
3 months ago
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 assisting Initial Clinical Reviewers.
Point32Health
The Behavioral Health Utilization Management Clinician conducts benefit coverage reviews and utilization management according to regulatory guidelines, aiming to ensure clinically appropriate service delivery and support organizational goals. Key duties include adhering to review guidelines, interacting with staff and providers, prioritizing authorization requests, and reviewing various service requests like inpatient admissions and outpatient procedures.
$81,218 - $121,827 / YEAR
ISLAND PEER REVIEW ORGANIZATION INC
The Clinical Reviewer conducts clinical level reviews for Independent Dispute Resolution cases, including documentation screening and preparing final determinations. They also act as a resource for staff and provide training and mentoring to new team members.
$38 - $43 / HOUR
The Clinical Reviewer processes requests for independent reviews by performing case reviews based on regulatory guidelines and clinical knowledge. They also formulate case summaries for physician reviewers and maintain correspondence with contractors, providers, and beneficiaries.
5 months ago
