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Clinical Claim Review jobs

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CLINICAL CLAIM REVIEW RN - MEDICAL DISABILITY - REMOTE

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...

CompanyOptum
AddressNashville, TN
CategoryHealthcare
Salary$28.03 - $54.95 an hour
Job typeFull-time
Date Posted 2 weeks ago See detail

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 weeks ago seen See more...

Clinical Claims reviewer LVN - CA Remote

Optum

El Segundo, CA

$19.47 - $38.08 an hour

Performing a retrospective review of claims received for care and services in both the inpatient and outpatient setting utilizing the appropriate resources within the parameters of established contracts and patients health plan b...

a month ago seen See more...

Home Health Pre Claim Reviewer - Remote

Reliant At Home

El Paso, TX

Responsible for preparing, organizing, submitting all Palmetto payor patients billing episodes into eServices. Ensures compliance with all State and Federal regulations prior to submission. Meets daily and weekly quota of chart su...

4 days 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...

4 days 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...

6 days ago seen See more...

Medical Claims Review Coordinator-San Antonio, TX

Optum

San Antonio, TX

$43.9K - $55.6K a year

Research and resolve UM inventory accordingly to meet productivity and quality standards to include:. Claims reports with reconciliation needs. Information received through Right Fax. Information received through email. Or any oth...

2 weeks ago seen See more...

Remote Medical Claim Review LVN - Work PST Hours

Molina Healthcare

Long Beach, CA

$21.60 - $46.81 an hour

Performs clinical/medical reviews of retrospective Medical Claim Reviews, Medical Claims and previously denied cases, in which an appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims p...

2 weeks 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 weeks 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 weeks ago seen See more...

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 weeks 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 weeks 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 weeks 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...

3 weeks 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 weeks ago seen See more...

Claim Reviewer

Dental Dreams

Chicago, IL

$47.4K - $60K a year

The benefits package includes:Medical & Vision InsuranceFree dental treatmentPTO401K Medical & Vision Insurance Free dental treatment PTO 401K Reviews Claims Gather Claim Information Submit Findings Follow up on outstanding claims...

3 weeks 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 weeks 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 weeks 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...

3 weeks 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...

3 weeks 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...

3 weeks ago seen See more...

OASIS/Clinical Record Review Nurse

Safrest

New York, NY

Monday through Friday (hybrid inBrooklyn). Benefits: PTO, 401(k) with a 5% match, FSA, and more! Prospectively reviews all OASIS assessments to ensure appropriateness, completeness, and compliance with federal and state regulatio...

2 weeks 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...

3 weeks 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...

3 weeks 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...

3 weeks ago seen See more...

Client Relationship Manager - Medical Claim/Bill Review

Alaffia Health

Remote

$90,000 - $110,000 a year

Managing a portfolio of clients to achieve operation objectives, retain revenue, and identify upsell opportunities. Understand client scope of work and serve as the client advocate when working with internal teams to ensure that c...

3 weeks ago seen See more...

Clinical Nurse Reviewer, Specialty Solutions

Clario

Remote

$74K - $93.7K a year

Reviewing study requirements and endpoint definitions and collaborates with key stakeholders to develop study start-up activities and associated documents for endpoint adjudication Assists the Clinical Endpoint Project Manager in...

3 weeks ago seen See more...

Clinical Review Nurse - Concurrent Review

Fidelis Care

Getzville, NY

$25.00 - $44.85 an hour

Performs Concurrent Reviews of member for appropriate care and setting to determine overall health and appropriate level of care Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of sta...

4 weeks ago seen See more...

Clinical Pharmacist Reviewer- REMOTE

Prime Therapeutics

Remote

$109,480 - $186,120 a year

Pharmacy Data Review: Regularly reviews and monitors prescription claims data and prescribing practices identified as outliers by internal and/or external analysis of pharmacy claims data. Telephonic Consultations/Interventions: C...

3 weeks ago seen See more...

Clinical Reviewer Specialist

Psychotherapeutic Services Inc

Dover, DE

$47.3K - $59.9K a year

clinical oversight and quality assurance to program staff and unlicensed and licensed clinicians who provide community-based mental health, addictions, and or behavioral healthcare services adherence to all applicable licensing, s...

4 weeks ago seen See more...

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

Unitedhealth Group

Dallas, TX

Ensure timely processing of all denial- related and member-oriented written communications from naviHealth. Ensure that all denial information is processed according to protocol and that all documentation is timely and meets all F...

a month ago seen See more...

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People who searched for Clinical Claim Review jobs also searched for Clinical Lab Scientist, Clinical Team Lead, Clinical Lab, Clinical Nurse Manager, Claims Resolution Specialist, Pediatrics Clinic, Clinical Manager Home Health, Clinical Documentation Integrity Specialist, Associate Clinical, Clinical Sales, Clinical Quality, Clinical Instructor, Outpatient Clinical, Clinical Practice, Clinical Pharmacy, . If you're getting few results, try a more general search term. If you're getting irrelevant result, try a more narrow and specific term.

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What are the top cities open Clinical Claim Review jobs?

There are open Clinical Claim Review jobs in several cities including Minnetonka, Metairie, Phoenix, Boise, Rancho Cucamonga, Eden Prairie,

What companies are hiring for Clinical Claim Review jobs?

The top companies hiring now for Clinical Claim Review jobs are Optum,

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