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CLINICAL REVIEWER, GRIEVANCE & APPEALS - REMOTE

Prepare and present clinical summations/recommendations to the Medical Director or Pharmacist, or Independent Review Organization in accordance with state and federal regulations, NCQA requirements, and internal policy for final c...

CompanyConnecticare
AddressNew York, NY
CategoryEducation/Training
Salary$63,000 - $110,000 a year
Job typeFull-time
Date Posted 2 months ago See detail

Clinical Reviewer, Grievance & Appeals - Remote

Connecticare

New York, NY

$63,000 - $110,000 a year

Prepare and present clinical summations/recommendations to the Medical Director or Pharmacist, or Independent Review Organization in accordance with state and federal regulations, NCQA requirements, and internal policy for final c...

2 months ago seen See more...

Clinical Appeals RN

Bjc Healthcare

Saint Louis, MO

Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date. Disability insurance* paid for by BJC. Pension Plan*/403(b) Plan funded by BJC. 401(k) plan with BJC match....

a week ago seen See more...

Registered Nurse- Risk Manager Clinical Reviewer

Department Of Veterans Affairs

Martinsburg, WV

Competitive

Demonstrates knowledge in the interpretation and application of accrediting body standards and other agency requirements. Assists with monitoring of various aspects of care provided to Veterans and the analysis and interpretation...

a week ago seen See more...

Senior Clinical Appeals Coordinator

Adecco

Minneapolis, MN

$ 21.68 - $ 23.68 / Hour

Weekly Pay. 401(k) Plan. Skills Training. Excellent medical, dental, and vision benefits....

2 weeks ago seen See more...

Supervisor - Clinical Review (Full-time - Salaried/Exempt) Washington State

Kaiser Permanente

Spokane, WA

Monitors and acts on daily operations of the Clinical Review, Case Management, and Code Review nursing staff using daily management systems. Manages and monitors daily work product of the Clinical Review, Case Management and Code...

2 weeks ago seen See more...

Clinical Coding Reviewer

R1 Rcm

Boise, ID

+ Draft appeal letters that are well written, logically structured, and persuasive, utilizing ICD-9/10 CM & PCS, CPT, HCPCS, NCCI guidance, and Coding Clinic. We believe in giving back to the community and offer a competitive bene...

3 weeks ago seen See more...

AR Clinical Appeals Nurse - Hybrid

Uofl Health

Louisville, KY

Ensures clinical interventions are appropriate for the admitting diagnosis and reflects the standard of care as defined by the medical staff and health system. Utilizes clinical knowledge and defined standards of care to proactive...

4 weeks ago seen See more...

Clinical Review Nurse - Prior Authorization

Bcforward

Indianapolis, IN

Clinical Review Nurse - Prior AuthorizationBC Forward is looking for Clinical Review Nurse - Prior Authorization (Remote Work) Position Title: Clinical Review Nurse - Prior Authorization (Remote Work) Locations: Remote IN (Local t...

4 weeks ago seen See more...

Registered Nurse Clinical Reviewer PRN

Corpus Christi Medical Center Bay Area

Corpus Christi, TX

Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transporta...

a month ago seen See more...

Clinical Review Nurse I (US)

Elevance Health

Waukesha, WI

Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy and other materials. . Requires AS in nursing and minimum of 1 year of clinical experience; or any combination of...

a month ago seen See more...

Clinical Appeals Nurse

Caresource

Remote

$60,300 - $96,500 a year

Responsible for the completion of Clinical Appeals and state hearings from all states Review and complete all provider Clinical Appeals within required timeframes Review and complete member Clinical Appeals within required timefra...

2 months ago seen See more...

Clinical Reviewer - Remote (IN PASRR)

Maximus Services, Llc

Virginia, United States

$24 - $29 an hour

Paid Time Off Tuition Reimbursement Quarterly Bonus Opportunities Work/Life Balance Growth and Development Responsible for completing medical and/or behavioral health assessments within contract requirements. Conducts on-site, vid...

2 months ago seen See more...

Pharmacist - Clinical Reviewer

Elevance Health

Indiana, United States

Researches and synthesizes detailed clinical data related to pharmaceuticals. May review and approve or deny coverage for pharmaceuticals (as permitted by state/federal law or state/federal program contracts) based on medical nec...

2 months ago seen See more...

Surgical Clinical Reviewer - Bariatrics

Hartford Healthcare

Shelton, CT

This task is accomplished through high-quality data compilation, documentation, and entry of 100 percent of bariatric procedures performed at the center. Qualifications EducationBachelor of Science in Nursing (BSN); Bachelors Deg...

2 months ago seen See more...

Clinical Reviewer (Medical Coding Academy - COC) San Juan, PR

Optum

San Juan, PR

$64.3K - $81.4K a year

Clinical Case Reviews -75%Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported.Maintain standards for productivity and accuracy. Standards are defin...

2 months ago seen See more...

Clinical Appeals Nurse (Remote)

Carefirst Bluecross Blueshield

Owings Mills, MD

$65,808 - $130,702 a year

Investigates, interprets, and analyzes written appeals and reconsideration requests from multiple sources including applicants, subscribers, attorneys, group administrators, internal stake holders and any other initiators. Respond...

2 months ago seen See more...

Clinical Appeals Nurse RN

Parallon

Largo, FL

Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transporta...

2 months ago seen See more...

Clinical Appeals Registered Nurse

Managed Resources

Remote

$30 - $40 an hour

Write quality appeal letters to achieve maximum overturn rate. Ensure workload is completed in an efficient and timely manner. The Clinical Appeals Review Nurse will review the case, and determine the potential for a Provider Appe...

2 months ago seen See more...

Cardiovascular Services Clinical Reviewer (Business Data Analyst 3)

Oregon Health & Science University

Portland, OR

identifies patients for inclusion in applicable registries. navigates the electronic medical record system, Epic, to abstract concurrent and retrospective data on all patients meeting national registry guidelines. finds, reads, an...

2 months ago seen See more...

Clinical Review Coordinator - Remote in PST, MST, CST or HI

Optum

Dallas, TX

$33.75 - $66.25 an hour

All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.. Ensure timely processing of all denial- related and member-oriented written communications from naviHealth. Ensure that all denial informat...

2 months ago seen See more...

Pharmacist - Clinical Reviewer

Elevance Health

ATLANTA, GA

Researches and synthesizes detailed clinical data related to pharmaceuticals. May review and approve or deny coverage for pharmaceuticals (as permitted by state/federal law or state/federal program contracts) based on medical nec...

2 months ago seen See more...

APP Clinical Reviewer (1099)

Tapestryhealth

Remote

$96K - $122K a year

Review all curated patient data reports received for accuracy of clinical and demographic information; Review output of clinical care algorithms for accuracy and appropriateness in the context of each patients medical history, ca...

2 months ago seen See more...

Physician Clinical Reviewer- Rheumatology- REMOTE

Prime Therapeutics

Boise, ID

+ Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. + Assists the VP, Medical Affairs in research activities/questions related to the Utilization...

2 months ago seen See more...

Clinical Review Nurse

Novitas

United States

$51.1K - $64.7K a year

Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire. Short- and long-term disability benefits. 401(k) plan with company match and immediate vesting. Free teleh...

2 months ago seen See more...

Clinical Review RN

Centers Plan For Healthy Living

Margate, FL

$80.2K - $102K a year

Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. Reviews Outcome Assessment Information Set (OASIS) and visit documentation for errors...

2 months ago seen See more...

Remote Clinical Denials and Appeals Nurse

Aspirion Health Resources Llc

Remote

From $68,000 a year

Manages complex and robust queue according to Aspirion and client needs. Queue size varies weekly. Reviews insurance denials, including but not limited to, medical necessity denials, patient status denials (i.e., Inpatient vs. Out...

a month ago seen See more...

Clinical/Utilization Review Nurse

Aspirion Health Resources Llc

Remote

From $68,000 a year

Manages complex and robust queue according to Aspirion and client needs. Queue size varies weekly. Reviews insurance denials, including but not limited to, medical necessity denials, patient status denials (i.e., Inpatient vs. Out...

2 months ago seen See more...

Clinical Claim Review RN - Medical Disability - Remote

Optum

Nashville, TN

$28.03 - $54.95 an hour

Remain up to date with the contract requirements. Use clinical judgement to ensure a clear, comprehensive, and concise exam documentation that is reflective of the patients service level conditions and in compliance to contract r...

2 months ago seen See more...

Manager of Peer Review and Clinical Support

Salem Health Hospitals & Clinics

Salem, OR

From $41.18 an hour

Relocation assistance available for qualified candidates. Full comprehensive medical, dental, and vision plans. Basic and voluntary life insurance. Short and long-term disability. Live Well Wellness Program. Employee Assistance Pr...

2 months ago seen See more...

Clinical Documentation Reviewer/Data Entry

Home Health Strategic Management

Lansing, MI

$17 - $21 an hour

Professional communication with office staff and healthcare professionals (via email and phone). Basic knowledge of medical terminology. Experience working in Medical Records preferred. Proficient in all Microsoft applications E...

2 months ago seen See more...

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