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CLAIMS SYSTEM CONFIGURATION QUALITY REVIEW SENIOR ANALYST - EVICORE - REMOTE

Resolve non-routine issues escalated from leadership, business, clients and junior team members and act as a subject matter expert (SME) to business and IT for eviCore claims product setups/processes Collaborate with internal and...

CompanyThe Cigna Group
AddressFranklin, TN
CategoryInformation Technology
Job typeFull-time
Date Posted 23 hours ago See detail

Claims System Configuration Quality Review Senior Analyst - eviCore - Remote New

The Cigna Group

Franklin, TN

Resolve non-routine issues escalated from leadership, business, clients and junior team members and act as a subject matter expert (SME) to business and IT for eviCore claims product setups/processes Collaborate with internal and...

Auditor, Clinical Services - UM (Remote in TX) - Now Hiring

Molina Healthcare

Houston, TX

$23.76 - $51.49 per hour

Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM). Monitors key cl...

Senior Clinical Trial Manager (Remote) - 24-108

Elevar Therapeutics, Inc

United States

$165,000 - $185,000 a year

Collaborate with the operational project team members and Finance stakeholders to oversee clinical study vendor(s) to ensure compliance with the contracted study specifications (i.e., timelines, deliverables) Lead the Clinical Ope...

MHPAEA Clinical Reviewer

Willis Towers Watson

Olin, NC

Prepare NQTL carrier data requests on behalf of each client. Coordinate with Project Manager regarding sending requests, timing, status, and follow-up. Attend internal and client kick off meeting with QTL/NQTL team. Monitor carri...

RN Pre-Service Clinical Review

Kaiser Permanente

Renton, WA

Conducts Clinical Review of coverage request based on the application of medical necessity criteria, understanding of individual coverage contracts and ability to meet Kaiser Foundation Health Plan of Washington, coding rules and...

Clinical Nurse Navigator-Days (Not Remote)

University Hospitals

Ohio, United States

DescriptionProvides virtual clinical care to patients within the recognized scope of practice for the profession and professional licensure requirementsProvides clinical triage and clinical support using established protocols duri...

Registered Nurse Clinical Denials & Appeals Reviewer

Administrative Regional Training Cntr

Buffalo, NY

$36.19 - $54.29 an hour

Registered Nurse with a current New York State license Bachelor of Science Nursing degree Holds, or will obtain within one (1) year of hire, one of the following (or similar) credentials: Certified Documentation Specialist, Certif...

Product Surveillance Clinical MDR Specialist II (Remote)

Arthrex

Naples, FL

Responsible for evaluation of complaints with respect to United States and International adverse event reporting regulations. Performs submission of adverse event reports to United States and International regulatory agencies Meet...

Remote Licensed Clinical Social Worker

Grow Therapy

Bridgeport, CT

$72 - $100 an hour

Free, hassle-free credentialing with major insurers: Under the Grow umbrella youll get paneled for free with the major payors in your state so you can also start seeing insurance clients. Referral stream + marketing partnerships...

Clinical Review Nurse I - Medicare Part B (US)

Elevance Health

Atlanta, GA

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...

Pediatric Speech-Language Pathologist (remote position for Hawaii clinic)

Sprouts Therapy

Hawaii, United States

$45 - $47 an hour

Pediatric Speech Therapist (Remote). Pediatric Feeding Occupational Therapist (Remote). Full-Time Schedule Coordinator (pre-builds caseload for new hires, fills cancellations when able, communicates directly with clients regarding...

Clinical Research Associate Manager - Central Region (Remote)

Merck

Rahway, NJ

Work allocation, staff development and performance appraisal.. Provides input for capacity planning, including reporting of current manpower and forecasting of CRA capacity and needs, to provide efficient use of resources.. Work w...

RN Clinical Reviewer

Rio Grande Regional Hospital

McAllen, 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...

Clinical Nurse Review - II

Progressive Technology Solutions

Owings Mills, MD

$35 - $39 an hour

8 hour shift. Owings Mills, MD 21117: Relocate before starting work (Required)....

Outpatient Licensed Clinical Social Worker (fully remote)

Lifebulb

Hampton, VA

Up to $100,000 a year

Provide direct in-session care for your clients. Complete session documentation. Reschedule clients as you see fit & maintain your caseload. High client demand, Quick caseload growth. Guaranteed pay per session (no guess work or w...

Nurse Practitioner (NP) Director of Clinical Quality (REMOTE)

Vesta Healthcare

Remote

$145,000 - $165,000 a year

Develop, design, revise, and execute our comprehensive Clinical Quality program and educate the team on continuous quality improvements. Collaborate extensively with Nurse Practitioners, collaborating physicians, nursing staff, ot...

per diem Clinical Care Manager RN -mostly remote

Vns Health

New York, United States

$49.55 - $61.96 per hour

Attractive sign-on bonus and referral bonus opportunities . Generous paid time off (PTO), starting at30 days of paid time offand 9 company holidays . Health insurance plan for you and your loved ones, Medical, Dental, Vision...

Clinical Research Medical Director, Endocrinology - US, Remote

Biospace

Washington, DC

Provide clinical/scientific knowledge into the development, design, delivery and communcation of the global evidence generation plan for the maridebart cafraglutide (AMG 133) phase 3 program. Support cross-functional and global co...

Clinical Research Medical Director, Endocrinology - US, Remote

Amgen

Washington, DC

Provide clinical/scientific knowledge into the development, design, delivery and communcation of the global evidence generation plan for the maridebart cafraglutide (AMG 133) phase 3 program.. Support cross-functional and global c...

Clinical Business Operations Representative 3 - Hybrid/Remote

University Of Miami

Miami, FL

$34.6K - $43.8K a year

Assists the department in managing expectations surrounding pre and post patient care. Obtains or reviews all patient demographic information, insurance information and referral numbers. Reviews clinical records for completeness i...

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...

Remote- Clinical Pharmacology, Modeling & Simulation- Senior Principal Scientist

Biospace

Thousand Oaks, CA

Plans all necessary non-compartmental analyses to support project team decisions, publications, and reporting. Designs Clinical Pharmacology components of drug development project clinical plans and provides Clinical Pharmacology...

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...

Remote Clinical Supervisor Board Certified Behavior Analyst (LBA, BCBA)

Highlights Healthcare

Mooresville, NC

Monday through Friday schedule No weekends. Competitive compensation starting at $75 per billable hour, commensurate with experience. Professional development opportunities. Company laptop. Train and supervise a team of Student An...

Full-time Remote Clinical Supervisor Community Based (LPC LCSW)

Ems Of Virginia

Richmond, VA

Responsible for following through with referrals and completing assessments (initial, reassessments, comprehensive assessments). Responsible for case assignment and maintenance of client care. Ensures that billable hours are achie...

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...

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...

Associate Director Global Clinical Program Management, Obesity - US, Remote

Biospace

Washington, DC

Line Management of Global Trial Managers (GTM)s. Supports Clinical Program Operations (CPO) Director/Snr Director in the following activities (leads activities in the absence of a director level e.g., on smaller programs):. Overal...

Associate Manager, Clinical Health Services (Remote)

Cvs Health

Tallahassee, FL

Fundamental Components Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g., NCQA, URAC, state and federal standards and mandates as applicable) Serve as a conte...

Patient Coordinator (Remote/Non-clinical) AccessNurse in null (Remote) at TeamHealth

Teamhealth

Remote

Are you seeking a remote position? And are you able to provide a HIPAA-compliant workspace? Are you looking to start a new career with a reputable health care company? Week 1: July 1-5, M-F 9a-5p Eastern (No Class On July 4th). We...