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CLINICAL REVIEW NURSE - PRIOR AUTHORIZATION

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...

CompanyBcforward
AddressIndianapolis, IN
CategoryEducation/Training
Job typeContractor
Date Posted 5 days ago See detail

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...

5 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...

2 weeks 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...

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...

3 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...

3 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...

3 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...

3 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...

3 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...

4 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...

4 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...

4 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...

4 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...

4 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...

a month 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...

a month 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...

a month 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...

a month 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...

Registered Nurse Clinical Reviewer

Hca Healthcare

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...

2 months ago seen See more...

Clinical Reviewer/ Auditor

Amdex Corporation

Rockville, MD

Performs desktop medical review and audit functions. Abstract review related data/information accurately and timely in appropriate review tools. Communicates with and supports physician reviewers in summarizing facts of cases and...

2 months ago seen See more...

Clinical Reviewer - The van Halem Group

Vgm Group, Inc

Remote

$47.4K - $60K a year

Review of clients patient medical files to determine coverage prior to the client billing insurance for claim payment Knowledge of contract specific guidelines Ability to interpret healthcare insurance guidelines, rules, and regu...

2 months ago seen See more...

LCSW, LMFT or LPC – PASRR Clinical Reviewer

Liberty Healthcare Corporation

Knoxville, TN

$70.5K - $89.2K a year

Travelling to hospitals, nursing homes, and long-term care facilities, and other locations in the region. Meeting in-person with people who are experiencing mental illness and/or living with an intellectual and developmental disab...

2 months ago seen See more...

Evaluations Clinical Reviewer

Bright Start Pt & Pta, Pllc

Remote

$60.5K - $76.5K a year

Health insurance. Paid time off. Choose your own hours....

2 months ago seen See more...

Clinical Review Nurse-I

Progressive Technology Solutions

Owings Mills, MD

$34 - $39 an hour

Ability to effectively communicate and provide positive customer service to every internal and external customer. Strong interpersonal skills. Ability to work independently, as well as a member of a team. Current knowledge of clin...

2 months ago seen See more...

Clinical Review Coordinator - Remote in Mountain Time Zone

Optum

Billings, MT

$33.75 - $66.25 an hour

By serving as the link between patients and the appropriate health care personnel, the SICC is responsible for ensuring efficient, smooth, and prompt transitions of care. Perform Skilled Nursing Facility (SNF) assessments on patie...

2 months 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...

3 weeks 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...

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...

3 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...

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...

3 weeks ago seen See more...

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What are the top cities open Clinical Reviewer jobs?

There are open Clinical Reviewer jobs in several cities including Bloomfield, Wallington, Nashville, Jackson, Harrisburg, Watertown, Birmingham, Canton, Riverside, Albuquerque, Bloomfield, Omaha, Sacramento, New Rochelle, Mount Clemens,

What companies are hiring for Clinical Reviewer jobs?

The top companies hiring now for Clinical Reviewer jobs are Acentra Health, Blue Cross of Idaho Health Service, Inc., Blue Cross of Idaho Health Service, Inc., Children's Health, Comagine Health, CVS Health, ezURs, Health First, Infirmary Health, TapestryHealth,

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