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Oversight Reviewer (Home Health Agencies)
Alignstaffing - 8 reviews - Washington, DC
$80,000 - $90,000 a year
Home health agencies shall not pre-select records for the Oversight Reviewer to review at the site visits....
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PARD Manager
Florida Blue - 312 reviews - Dallas, TX 75270
Establishes reimbursement for services, ensures that assigned staff updates interim rates and other payment factors, ensures that all changes are entered into...
Licensed Utilization Review Nurse II (Call Center Nurse) - R...
Anthem, Inc. - 2,564 reviews - Norfolk, VA 23501
May access and consult with peer clinical reviewers, Medical Directors and/or delegated clinical reviewers to help ensure medically appropriate, quality, cost...

OPM Case Reviewer: Level 1

CSRA - 237 reviews - Remote
Conducts analysis of current claims trends and investigates means to improve claim processes. May review various types of claims such as property and casualty...

Clinical Reviewer

Kaiser Permanente- Washington Permanente Medical G... - 6,060 reviews - Renton, WA
Clinical Reviewer, Specialized Medical Ability Resource Program*. The SMARTeam Clinical Reviewer serves as a clinical resource to WPMG clinicians for disability...
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Healthcare Claims Reviewer

DXC Technology - 994 reviews - Madison, WI
Approves any remedial or recoupment actions associated with escalated claims. Provides expertise to investigate and adjudicate claim characteristics that do not...

Clinical Reviewer RN

Cigna - 2,675 reviews - Nashville, TN
Understand and investigate billing issues, claims and other plan benefit information. The Appeals Reviewer reports to the Supervisor/Manager of Appeals and will...

Medical Claims Negotiator / Chatsworth

Health Advocates - 31 reviews - Chatsworth, CA
Parties for prompt resolution on claims. Specialist, Business Office Representative, Paralegal, Plan Claim. Liability, Recovery, Revenue, Claims, Analyst, TPL,...

Clinical Case Reviewer (West Coast Hospitalist)

National Medical Reviews, Inc - Remote
Under the direction of the Chief Medical Director, provides peer reviews services, which may include but not limited to, benefit coverage opinions, case reviews...
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Clinical Panel Reviewer (Infectious Disease)

National Medical Reviews, Inc - Remote
Under the direction of the Chief Medical Director, provides peer reviews services, which may include but not limited to, benefit coverage opinions, case reviews...
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Medical Researcher

Havas - 20 reviews - New York, NY
Annotate marketing materials to support claims in preparation for MLR/OPDP submissions. The claims that need sourcing are written for consumers but they need to...

Secondary Reviewer Physician

Universal Consulting Services - 14 reviews - Fairfax, VA 22033
Provide recommendations by preparing a Standard Naval letter that either supports the initial denial or reverses the TSGLI claim utilizing a computer based...

Program Specialist

Veterans Affairs, Veterans Health Administration - 3,496 reviews - Portland, OR
$52,745 - $68,571 a year
Creates presentation materials, assigns committee and/or subcommittee reviewers, coordinates schedules using electronic mail, phone, and person-to-person...
Nurse Medical Management I - Sr - Waukesha, WI - #137440
Anthem, Inc. - 2,564 reviews - Milwaukee, WI 53201
Works with medical directors in interpreting appropriateness of care and accurate claims payment. Consult with clinical reviewers and/or medical directors to...
Clinical Pharmacist Reviewer
Magellan Health - 440 reviews - Orlando, FL 32812
Title Clinical Pharmacist Reviewer. Regularly reviews and monitors prescription claims data and prescribing practices identified as outliers by internal and/or...