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Medical Director - Remote
Fidelis Care - 200 reviews - Rego Park, NY 11374
Evaluates authorization requests in a timely manner and provides support for nurse reviewers and manages the denial process....
Lead Clinical Review Nurse
Novitas Solutions, Inc. - Mechanicsburg, PA 17050
Serve as Technical expert of the claims processing system, claims payment policies and procedures, Medicare regulations and CMs requirements:....
Utilization Review Nurse
RehabWest, Inc. - San Marcos, CA
Communicate with physician reviewers to discuss cases and provide input, as requested. Communicate with claims administrators to discuss cases and evaluate the...
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Medical Reviewer

Katalyst Healthcares & Life Sciences - San Jose, CA   +1 location
Determine if indication and claims for products are supported by clinical data. Review IFUs and product claims for specified client products and suggest changes...

Associate Regulatory Affairs Specialist

Medtronic - 1,314 reviews - Santa Rosa, CA 95403
Assist in developing and maintaining positive relationships with device reviewers through oral and written communications....

OPM Case Reviewer: Level 1

CSRA - 208 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...

HIM-Subject Matter Expert

Altegra Health - 246 reviews - Pasadena, CA
Directly oversees a staff of 8 reviewers who review hospital, professional, and hospice claims for coding and billing accuracy....

Utilization Review Physician Telecommute Occ Med Austin, TX...

Concentra, Inc. - 1,035 reviews - Austin, TX
Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer....

Claims Nurse Reviewer

Conduent - 755 reviews - Anchorage, AK
Insurance Claim Administration; Negotiates liability settlement of medical claims with third parties or healthcare providers;...

Licensed Utilization Review I/II/Senior - CA

Anthem, Inc. - 2,430 reviews - Woodland Hills, CA 91367
May access and consult with peer clinical reviewers, Medical Directors and/or delegated clinical reviewers to help ensure medically appropriate, quality, cost...

APPEALS COORDINATOR

Geisinger - 32 reviews - Danville, PA
The Coordinator is responsible for presentation of the Member appeal to the Plan Medical Staff and Center for Medicare/Medicaid Services (GOLD line of business)...

Developmental Behavioral Pediatrics

AllMed Healthcare Management, Inc - 9 reviews - Remote
DEVELOPMENTAL BEHAVIORAL PEDIATRICS – MEDICAL REVIEWER. AllMed Healthcare Management helps healthcare payers to reduce claims costs, while ensuring consistent...

2017-2596

Crawford & Company - 238 reviews - Jacksonville, FL 32256
The Crawford Solution® offers comprehensive, integrated claims services, business process outsourcing and consulting services for major product lines including...
Nurse Reviewer - RN
MJ Morgan Group - 11 reviews - Bridgewater, NJ
KEY RESPONSIBILITIES of the Nurse Reviewer:. PROFESSIONAL EXPERIENCE and QUALIFICATIONS of Nurse Reviewer:....
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PHYSICIAN (Physician Advisor)
Veterans Affairs, Veterans Health Administration - 3,323 reviews - Dallas, TX
$101,967 - $225,000 a year
Serve as second level reviewer for UM, providing guidance on appropriate/alternate levels of care based on InterQual ® guidelines and other appropriate criteria...