Physician Reviewer
3 weeks ago
Pay Range: $115-$118/hr. Remote Position does not provide direct patient care or medical diagnosis.) Medical Director must reside in Illinois, Montana, New Mexico, Oklahoma or Texas. M-F Evaluates clinical service requests made by an organization's members and providers. Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests. May also provide clinical leadership in other areas of the organization. Identifies opportunities to manage members' clinical situations with a view toward creative problem solving and anticipation of possible future clinical problems for the member. Participates in the process to evaluate clinical service requests. Practices anticipatory case management for members whose cases come for review, in partnership with case managers. Participates in the Physician Review Units' appeal process of service denials. Participates in the development of Physician Review Units' policies and procedures. Actively participates in all unit continuous quality improvement activities. Other duties as assigned by the Medical Director. Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine requested and 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background. Must have understanding of managed care and demonstrate PC proficiency, as file review will be done via computer in most cases. (Note: Position does not provide direct patient care or medical diagnosis.) Medical Director must reside in Illinois, Montana, New Mexico, Oklahoma or Texas.
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Physician Reviewer
3 weeks ago
Nashville, United States EPITEC Full timeLocation: Fully remote position; Must reside in TN, IL, MT, NM, OK, or TXEmployment Type: Full-Time ContractPay: $120 per hourDescription: We're seeking a Board-Certified M.D. or D.O. to join our team as a Physician Reviewer. In this role, you'll apply clinical judgment to evaluate service requests, support case management, and contribute to continuous...
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Physician Reviewer
6 days ago
Nashville, United States Mindlance Full timeremote position; we can consider candidates from our other six states pay should align to conversion salary M-F Evaluates clinical service requests made by an organization's members and providers. Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests. May also provide clinical leadership in other areas of the...
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Physician Reviewer
7 days ago
Nashville, TN, United States Mindlance Full timeremote position; we can consider candidates from our other six states pay should align to conversion salary M-F Evaluates clinical service requests made by an organization's members and providers. Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests. May also provide clinical leadership in other areas of the...
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Physician Reviewer
5 days ago
Nashville, TN, United States Mindlance Full timeremote position; we can consider candidates from our other six states pay should align to conversion salary M-F Evaluates clinical service requests made by an organization's members and providers. Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests. May also provide clinical leadership in other areas of the...
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Physician Reviewer
4 days ago
Nashville, TN, United States Mindlance Full timeremote position; we can consider candidates from our other six states pay should align to conversion salary M-F Evaluates clinical service requests made by an organization's members and providers. Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests. May also provide clinical leadership in other areas of the...
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Physician Reviewer
1 day ago
Nashville, TN, United States Mindlance Full timeremote position; we can consider candidates from our other six states pay should align to conversion salary M-F Evaluates clinical service requests made by an organization's members and providers. Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests. May also provide clinical leadership in other areas of the...
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Physician Reviewer
2 weeks ago
Nashville, TN, United States w3r Consulting Full timeJob Summary: The ideal candidate will leverage their extensive clinical experience to enable delivery of CSBs market-leading strategies, improving the lives of the individuals we serve. The CSB Medical Director will work closely with CSBs National Medical Director and CSB leadership to identify opportunities to manage and improve clinical reviews and...
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Utilization Review Nurse
2 weeks ago
Nashville, United States Netsmart Full timeUtilization Review Nurse Responsible for utilization review work for emergency admissions and continued stay reviews. Responsibilities: Review and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteria. Apply evidence-based clinical guidelines and criteria to assess and ensure...
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CDI Concurrent Review and Query Specialist
5 days ago
Nashville, United States HCA Full timeDescription This is a fully remote role but you must live within 60 miles of an HCA facility Introduction Do you want to join an organization that invests in you as a CDI Concurrent Review and Query Specialist? At HCA Healthcare, you come first. HCA Healthcare has committed up to 300 million in programs to support our incredible team members over the course...
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Nurse Reviewer I
6 days ago
Nashville, United States Nashville Staffing Full timeNurse Reviewer I This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if...
