Medical Review Specialist
2 weeks ago
We are seeking a highly skilled Medical Review Specialist to join our team at w3r Consulting. As a key member of our team, you will play a critical role in evaluating medical benefit medication service requests made by our organization's members and providers.
Key Responsibilities- Evaluate medical benefit medication service requests using clinical judgment and in conjunction with our organization's criteria, national guidelines, and standards.
- Utilize evidence-based scientific literature to adjudicate requests and provide clinical expertise to other areas of the organization.
- Participate in company and legally mandated processes to evaluate medical drug benefit service requests.
- Engage in scheduled peer-to-peer conversations with members and providers through our customer service line.
- Contribute to the development of our Specialty Review Units' policies, processes, and procedures.
- Participate in unit continuous quality improvement activities.
- Board Certified (ABMS) M.D. or D.O. with an unrestricted and active license to practice medicine.
- At least 5 years of clinical experience, including inpatient experience.
- Strong understanding of managed care and proficiency in PC software.
Please note that this position does not provide direct patient care or medical diagnosis.
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Medical Review Specialist
3 weeks ago
North Chicago, Illinois, United States SPECTRAFORCE Full timeJob Title: Medical Review Specialist (Dermatology)Location: 100% remoteDuration: 06 MonthsSPECTRAFORCE is seeking a Medical Review Specialist to support the US Immunology Medical Affair teams. As a Medical Review Specialist, you will provide medical oversight for scientific review and approval of promotional and medical materials in compliance with corporate...
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Medical Review Specialist
2 weeks ago
North Chicago, Illinois, United States SPECTRAFORCE Full timeJob Title: Medical Review Specialist (Dermatology)Location: Remote OpportunityDuration: 6 MonthsSPECTRAFORCE is seeking a Medical Review Specialist to support our US Immunology Medical Affairs teams.Responsibilities include:Providing medical oversight for scientific review and approval of promotional and medical materials in compliance with corporate...
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Pharmacist - Medication Review Specialist
20 hours ago
Chicago, Illinois, United States Spectraforce Technologies Full timeJob Title: Pharmacist - Medication Review SpecialistDuration: 6 monthsLocation: North Chicago, ILShift Hours: Mon-Friday - 8-hour shift, that hour could be anytime between 6 am and 10 pmResponsibilities:Reviews prescriptions issued by Physician, or other authorized prescriber to assure accuracy and determine formulas and ingredients needed.Directs pharmacy...
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Medical Review Specialist
5 days ago
Chicago, Illinois, United States PSG Global Solutions Careers Full timeJob Title: Physician ReviewerAt PSG Global Solutions Careers, we are seeking a highly skilled Physician Reviewer to join our team. As a Physician Reviewer, you will play a critical role in evaluating clinical service requests and providing clinical leadership in our organization.About the OpportunityWe are looking for a Physician Reviewer with 5 years of...
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Clinical Utilization Review Specialist
3 weeks ago
Chicago, Illinois, United States Centene Corporation Full timeJob Title: Clinical Utilization Review SpecialistCentene Corporation is seeking a highly skilled Clinical Utilization Review Specialist to join our Medical Management/Health Services team. As a key member of our team, you will play a critical role in ensuring that our members receive high-quality, medically necessary care.Job Summary:The Clinical Utilization...
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Chicago, Illinois, United States Concentra Full timeJob Summary:We are seeking a Board Certified Orthopedic Surgeon to join our medical review team as a telecommute specialist. This role provides the opportunity to work from home and customize your schedule and caseload within a Monday - Friday work week.Responsibilities:Reviews medical files and provides recommendations for utilization review, chart reviews,...
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Drug Utilization Review Specialist
5 days ago
Chicago, Illinois, United States destinationone Consulting Full timeJob Title: Drug Utilization Review SpecialistAt destinationone Consulting, we are seeking a highly skilled Drug Utilization Review Specialist to join our team. This role is responsible for evaluating medication use patterns to promote safe and effective medication therapy, ensuring optimal patient outcomes.Key Responsibilities:Conduct comprehensive drug...
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Drug Utilization Review Specialist
5 days ago
Chicago, Illinois, United States destinationone Consulting Full timeDrug Utilization Review SpecialistAt destinationone Consulting, we are seeking a highly skilled Drug Utilization Review Specialist to join our team. This role is a critical component of our healthcare recruitment efforts, and we are excited to find the right candidate to fill this position.Key Responsibilities:Conduct comprehensive drug utilization reviews...
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Drug Utilization Review Specialist
3 weeks ago
Chicago, Illinois, United States destinationone Consulting Full timeJob Title: Drug Utilization Review SpecialistAt destinationone Consulting, we are seeking a highly skilled Drug Utilization Review Specialist to join our team. As a key member of our healthcare recruitment team, you will play a crucial role in evaluating medication use patterns to promote safe and effective medication therapy, ensuring optimal patient...
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Medical Reviewer/Safety Specialist
6 days ago
Chicago, Illinois, United States Randstad North America, Inc. Full timeMedical Reviewer/Safety Reviewer I/IIAt Randstad North America, Inc., we are committed to connecting talented professionals with exciting opportunities in the life sciences arena. As a Medical Reviewer/Safety Reviewer I/II, you will play a critical role in ensuring the quality and safety of our clients' products and services.Key Responsibilities:Conduct...
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Medical Reviewer/Safety Reviewer III
2 days ago
Chicago, Illinois, United States Randstad Full timeJob Summary:As a leading staffing and recruitment agency, Randstad is committed to finding top talent for the life sciences industry. We're seeking a skilled Medical Reviewer/Safety Reviewer III to join our team and contribute to the development of innovative therapies.This role involves providing medical oversight for scientific review and approval of...
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Clinical Utilization Review Specialist
3 weeks ago
Chicago, Illinois, United States Innovative Systems Group Full timeJob SummaryWe are seeking a highly skilled and experienced Clinical Utilization Review Specialist to join our team at Innovative Systems Group. As a key member of our team, you will be responsible for ensuring compliance with utilization management and quality review functions performed by medical groups and IPAs participating in our networks.Key...
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HEDIS Review Nurse Specialist
4 weeks ago
Chicago, Illinois, United States Integrated Resources Full timeJob SummaryWe are seeking a highly skilled HEDIS Review Nurse to join our team at Integrated Resources. As a key member of our team, you will be responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS) survey.Key ResponsibilitiesAbstract medical records in accordance with NCQA...
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Clinical Review Specialist
4 weeks ago
Chicago, Illinois, United States Universal Health Services, Inc. Full timeJob SummaryWe are seeking a highly skilled Clinical Review Specialist to join our team at Universal Health Services, Inc. As a key member of our Utilization Management team, you will be responsible for performing timely and accurate clinical reviews with all payer types to secure authorization for initial and continued treatment.ResponsibilitiesConduct daily...
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Medical Reviewer
18 hours ago
North Chicago, Illinois, United States Spectraforce Technologies Full timeJob Title: Medical Reviewer/Safety ReviewerLocation: Mettawa IL 60045Duration: 12 MonthsHealth related background: BSN/PharmD, (at a minimum Pharma Experience, 1-5 yrs experience would be ideal) Experience with the application of FDA OPDP regulations, guidance regarding Advertising and Promotion (a plus would be for international regulations experience)...
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Medical Reviewer
5 days ago
North Chicago, Illinois, United States Randstad Life Sciences US Full timeJob Title: Medical ReviewerJoin Randstad Life Sciences US as a Medical Reviewer and play a crucial role in ensuring the accuracy and compliance of medical and commercial communications for our globally marketed products.Key Responsibilities:Implement policies to support accurate, high-quality, and compliant medical and commercial communications through...
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Medical Reviewer III
3 weeks ago
Chicago, Illinois, United States Randstad Full timeJob SummaryWe are seeking a highly skilled Medical Reviewer III to join our team at Randstad. As a Medical Reviewer III, you will provide medical oversight for scientific review and approval of promotional and medical materials in compliance with corporate standards and government/industry regulations.ResponsibilitiesProvide medical review consultant to...
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Medical Reviewer/Safety Reviewer I/II
2 days ago
Chicago, Illinois, United States Randstad Full timeJob SummaryWe are seeking a highly skilled Medical Reviewer/Safety Reviewer I/II to join our team at Randstad. As a key member of our Global Material Review team, you will be responsible for ensuring compliance with regulatory requirements and company policies related to medical content.Key Responsibilities:Monitor and review medical content for accuracy and...
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Medical Reviewer/Safety Reviewer I/II
6 days ago
Chicago, Illinois, United States Randstad Full time{"title": "Medical Reviewer/Safety Reviewer I/II", "description": "Job SummaryAs a leading staffing and recruitment agency, Randstad is committed to finding the perfect role for you in the life sciences arena. With a strong partnership with a research-driven biopharmaceutical company, we offer a unique opportunity to stand out in your field and lead the way...
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Medical Reviewer/Safety Reviewer III
2 weeks ago
North Chicago, Illinois, United States Randstad US Full timeJob Title: Medical Reviewer/Safety Reviewer IIIJoin Randstad US, the largest staffing and recruitment agency in the world, and take advantage of our extensive network of top employers in the life sciences arena. As a Medical Reviewer/Safety Reviewer III, you will have the opportunity to work with a renowned research-driven biopharmaceutical company that has...