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Quality Assurance Reviewer
Previous SC DDSN, Medicaid, Utilization Review, Case Management, Quality Assurance, Claims Auditing or Fraud/Abuse experience required....
Desired Experience: RN, Social Work License, Data Entry, Developmental Disabilities Experience, Auditing
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Healthcare Insurance Review Coordinator
Analyzing Reviewer responses for completeness and clarity. Serving as a liaison between clients, reviewers, and providers....
Desired Experience: Microsoft Word, Medical Terminology

Vice President, Contracts

Sterling, VA 20164
Participate as a senior reviewer in proposal milestones, color team reviews, and PMRs. Supervise, direct and manage all NCS contract related matters including...
Desired Experience: Leadership Experience

Quality Assurance Report Reviewer

Union, NJ
SGS Harrison Research Laboratory performs a full range of safety, efficacy and claim substantiation testing of cosmetics, toiletries and topically-applied...
Desired Experience: Laboratory Experience, Microsoft Office

Pharmacy Claims Reviewer CPhT

Cherry Hill, NJ
As a Pharmacy Claims Auditor/Reviewer, you’ll be tasked with examining a wide variety of pharmacy records against our client’s pharmacy claim data to ensure...
Desired Experience: Certified Pharmacy Technician, Microsoft Office, Infusion Experience

Pre-claims Billing Reviewer | On Site McKinney TX

McKinney, TX
Regional Business Specialist | Pre-claims Billing Reviewer. Review physician orders in preparation for claims submission....
Desired Experience: Medical Billing

Physician Reviewer - Pulmonologist - Remote

National Medical Reviews Inc
Greensboro, NC
Under the direction of the Chief Medical Director, provides peer reviews services, which may include benefit coverage opinions, case reviews, claims auditing,...
Desired Experience: Patient Care, BC/BE
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Medical Auditor

Healthcare claims experience helpful. As a Medical Reviewer you will be reviewing medical records to evaluate the accuracy of medical coding....
Desired Experience: RN, Medical Coding Certification, Microsoft Office, CPT Coding

Specialist, Medical Necessity Claims Reviewer (Nurse)

Troy, MI 48084
3 years clinical nursing experience, including 1 year Utilization Review and/or Medical Claims Review experience....
Desired Experience: Case Manager Certification, RN, LPN, CPT Coding, ICD-9, CPHQ

NY National -Utilization Management Representative I - Midla...

Refers cases requiring clinical review to a Nurse reviewer. Managing incoming calls or incoming post services claims work....

Nurse Reviewer - Facility Utilization Review

Honolulu, HI 96814 (Makiki area)
The Nurse Reviewer must follow each line of business requirements and each accrediting body's (CMS, NCQA, HSAG) requirements for each inpatient admission....

Nurse Medical Management Sr.-Remote (PS11653)

United States +2 locations
Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management...
Desired Experience: RN, Microsoft Office, Excel, Case Management, Managed Care
Utilization Management Reviewer, RN
Torrance Health IPA
Torrance, CA 90505
Assists in determining status of non-complex claims for reimbursement. The Utilization Management Reviewer, RN works closely with physicians, hospitals, and...
Desired Experience: RN
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Quality Assurance Coordinator
Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists....
Desired Experience: Microsoft Word, Medical Terminology
Medical Records Reviewer Sr
Respond to queries from our clients regarding claim folders. Reassembles and organizes VA claims folder according to established policies and procedures....
Desired Experience: Medical Coding Certification, Microsoft Office
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