Medical Record Review and Analysis Manager

About the RoleThis is an exciting opportunity for a skilled nurse to join our Utilization Management team as a Clinical Review Nurse. In this role, you will be responsible for conducting thorough reviews of prior authorization requests, analyzing medical records, and making informed decisions regarding coverage.You will work closely with our Medical Director...

Job Title: Clinical Reviewer LVNJob Type: Full-timeLocation: RemoteAbout Us:At Advanced Medical Manage, we are dedicated to providing high-quality healthcare services to our members. We are seeking an experienced Clinical Reviewer LVN to join our team.Job Summary:The Clinical Reviewer LVN will be responsible for reviewing requests for service authorizations...

About the Position:Molina Healthcare is seeking a highly skilled Clinical Review Nurse to join our team as a SIU Investigator. As a Clinical Review Nurse, you will be responsible for reviewing and analyzing information to make medical determinations and applying clinical knowledge to assess the medical necessity of services.Responsibilities:Review and...

Role OverviewThe Facility Compliance Review team at Blue Shield of CA reviews post-service prepayment facility claims for contract compliance, industry billing standards, and medical necessity. As a Utilization Management Nurse, Senior, you will be responsible for reviewing medical documents and applying clinical criteria to establish the most appropriate...

Job Title: Advanced Medical Manage NurseJob Type: Full-timeLocation: RemoteAbout Us:At Advanced Medical Manage, we are dedicated to providing high-quality healthcare services to our members. We are seeking an experienced UM Nurse to join our team.Job Summary:The UM Nurse will be responsible for conducting prospective and retrospective reviews of requests for...

ResponsibilitiesIn this pivotal role as Risk Adjustment Coder- Admin, you will be responsible for several critical tasks:Reviewing medical record information to identify, collect, assess, monitor, and document claims and encounter coding information related to Hierarchical Condition Categories (HCC)Auditing provider documentation of CPT, ICD-9, and ICD-10...

Job DescriptionWe are seeking an experienced Case Management Manager to join our team at Advanced Medical Manage.ResponsibilitiesReview inpatient cases and provide guidance to case managers for reviews, hospital transfers, observation, discharge planning, and transitions of care.Review outpatient cases and provide guidance to case managers for reviews, case...

Job OverviewAt Advanced Medical Manage, we strive to deliver exceptional patient care and outcomes. As a Case Management Manager, you will play a critical role in achieving this goal by leading our case management team and implementing evidence-based practices.Key ResponsibilitiesCollaborate with the senior leadership team to develop and implement case...

ResponsibilitiesPerform retrospective utilization reviews and first-level determination approvals for members using evidence-based guidelines, policies, and nationally recognized clinical criteria.Conduct clinical review of claims for medical necessity, coding accuracy, medical policy compliance, and contract compliance.Prepare and present cases to Medical...

Job Title: Medical Claims Audit ExpertAbout the RoleAt Advanced Medical Manage, we are seeking a highly skilled Medical Claims Audit Expert to join our team. As a key member of our audit team, you will play a critical role in ensuring compliance with regulatory requirements and optimizing our claims processing operations.ResponsibilitiesPrepare and...

We are seeking a talented Budget Analyst Manager to lead our financial planning and analysis efforts. In this role, you will develop and implement financial plans, analyze budget variances, and provide recommendations for cost savings and process improvements.The estimated salary for this position is $90,000 - $125,000 per year, based on industry standards...

Job DescriptionWe are seeking a highly motivated Financial Record Specialist to join our team at Patrice & Associates in Huntington, WV. The ideal candidate will have experience in preparing and analyzing financial records, developing reporting for business operations, and performing audits.The successful candidate will be responsible for creating new...

**Job Description:**Molina Healthcare is seeking a highly skilled HEDIS Data Abstraction and Quality Manager to join our team. This role is responsible for leading data collection and abstraction of medical records for HEDIS projects, HEDIS-like projects, and supplemental data collection.**Responsibilities:Manages the coordination and preparation of the...

ResponsibilitiesAs a Sr. Manager, Utilization Management Nurse Management, you will:Manage a high-functioning team with direct oversight of day-to-day operationsParticipate in process improvement/cost of health care initiativesHave a bachelor's degree or equivalent experienceHold a current California RN LicenseHave at least 10 years of prior relevant...

About the Role:The Principal Engineer will be responsible for overseeing spacecraft system engineering, including requirement derivation, system and subsystem requirement verification techniques, vehicle performance budgets, test methods and data analysis, simulation and analysis, technical leadership in future architectures, platform, and payloads for...

Job OverviewAt Advanced Medical Manage, we are seeking a highly skilled and detail-oriented Medical Prior Authorization Specialist to join our team. As a key member of our Utilization Management department, you will play a crucial role in ensuring that patients receive the necessary medical treatment and services.The ideal candidate will have a strong...

Job Title: Medical Records SpecialistAbout Us:E-Wave Form Lab Inc is a leading provider of drug-free pain relief solutions. Our team is dedicated to delivering exceptional results and improving patient outcomes.Job Summary:We are seeking a detail-oriented Medical Records Specialist to join our operations team in California. The ideal candidate will have...

Job Summary: Molina Healthcare Services works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. Our goal is to ensure that patients progress toward desired outcomes with...

Job Title: HEDIS Data Abstraction SpecialistAbout Our Company: Molina Healthcare is a leading provider of healthcare services to underserved communities. We are committed to delivering high-quality care to our members and striving for excellence in everything we do.Salary: The estimated annual salary for this position is around $80,000 - $105,000, depending...

About Rocket Lab">Rocket Lab is a global leader in launch and space systems. We enable some of the most ambitious and vital space missions globally, supporting scientific exploration, Earth observation and missions to combat climate change, national security, and exciting new technology demonstrations.Our team designs, creates, and puts together our own...