Medical Reviewer

Hours : 20-30 hours/week Contract: 06 months contract Purpose In this role, you will support and manage projects, provide medical input on branded and unbranded content, and participate in various initiatives. You will represent medical affairs in the Medical, Legal, and Regulatory (MLR) review process to ensure compliance with...

Hours : 20-30 hours/week Contract: 06 months contract Purpose In this role, you will support and manage projects, provide medical input on branded and unbranded content, and participate in various initiatives. You will represent medical affairs in the Medical, Legal, and Regulatory (MLR) review process to ensure compliance with industry...

Job Summary:Piedmont is seeking a highly skilled Clinical Appeals Specialist to join our team. As a Clinical Appeals Specialist, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key Responsibilities:Conduct detailed reviews of patient medical...

About the Role:Piedmont Healthcare Corporate is seeking a skilled Clinical Appeals Specialist to join our team. As a key member of our appeals process, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key Responsibilities:Conduct detailed...

Job SummaryPiedmont Healthcare Corporate is seeking a skilled Clinical Appeals Specialist to join our team. As a key member of our appeals process, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key ResponsibilitiesConduct detailed reviews of...

Job Title: HEDIS Nurse Abstractor SpecialistJob Summary:Spectraforce Technologies is seeking a highly skilled HEDIS Nurse Abstractor Specialist to join our team. As a HEDIS Nurse Abstractor Specialist, you will be responsible for reviewing medical records, abstracting pertinent data, and entering it into a specified database to support HEDIS reporting.Key...

Job DescriptionJob DescriptionDescription:Are you passionate about making a difference? The World Trade Center (WTC) Health Program provides support to those impacted by 9/11. This position for a medical claims review nurse on the World Trade Center (WTC) Health Program will have a direct impact on members of the program. The nurse will be responsible for...

Hours: 20-30 hours/week Contract: 06 months contract Objective In this position, you will oversee and facilitate projects, offer medical insights on both branded and unbranded materials, and engage in various initiatives. You will act as a representative of medical affairs in the Medical, Legal, and Regulatory (MLR) review process to guarantee...

Immediate need for a talented Medical Review Nurse - RN This is a 02+ Months Contract opportunity with long-term potential and is located in North Carolina, NC(Remote) . Please review the job description below and contact me ASAP if you are interested. Job ID:24-40151 Pay Range: $35 - $39/hour. Employee benefits include, but are not limited to, health...

Immediate need for a talented Medical Review Nurse - RN This is a 02+ Months Contract opportunity with long-term potential and is located in North Carolina, NC(Remote) . Please review the job description below and contact me ASAP if you are interested. Job ID:24-40151 Pay Range: $35 - $39/hour. Employee benefits include, but are not limited to, health...

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.Position Purpose Performs concurrent reviews, including determining member's...

Job Summary:Spectraforce Technologies Inc is seeking a highly skilled Quality Assurance Nurse Reviewer to join our team. As a Quality Assurance Nurse Reviewer, you will play a critical role in ensuring the accuracy and quality of medical records data.Key Responsibilities:Conduct quality assurance reviews of medical records to validate abstracted data and...

Position OverviewThe Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. Conduct review of facility and outpatient bills as it compares with medical records...

Position OverviewThe Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. Conduct review of facility and outpatient bills as it compares with medical records...

Job Description:The Clinical Review Specialist role at Sonder Health Plans is to ensure that healthcare services are administered with quality, cost efficiency, and within compliance.By continuously reviewing and auditing member treatment records, the Clinical Review Specialist will ensure members do not receive unnecessary procedures, ineffective treatment,...

Job DescriptionJob DescriptionJob Description:The Utilization Review Nurse’s role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing member treatment records, the utilization review nurse will ensure members do not receive unnecessary procedures, ineffective...

Job Description: The Utilization Review Nurse's role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing member treatment records, the utilization review nurse will ensure members do not receive unnecessary procedures, ineffective treatment, or experience...

Job Description:The Utilization Review Nurse's role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing member treatment records, the utilization review nurse will ensure members do not receive unnecessary procedures, ineffective treatment, or experience...

Position OverviewAre you dedicated to enhancing healthcare outcomes? KARNA LLC is seeking a skilled Medical Claims Review Nurse to contribute to our mission of supporting individuals affected by significant health events. This role is pivotal in ensuring that claims are meticulously reviewed for medical necessity and in addressing provider appeals...

Are you a detail-oriented RN with a knack for navigating complex medical cases? Do you thrive on making critical decisions that impact patient care? Join us as a Care Management Coordinator and play a key role in evaluating and authorizing essential healthcare services. Shift: Monday – Friday (8am – 5pm Normal business hours) Type: Temp to...