Clinical Reviewer

Job Title: Clinical Review SpecialistDane Street is seeking a skilled Clinical Review Specialist to conduct Group Health reviews. This role involves a clinical summary, potential calls to treating providers, and responses to questions posed.Key Responsibilities:Conduct thorough clinical reviews of Group Health casesPrepare and submit high-quality clinical...

Job Summary:Dane Street is seeking a skilled Clinical Review Specialist to conduct Group Health reviews. This role involves a clinical summary, potential calls to treating providers, and responses to questions posed.Key Responsibilities:Conduct thorough clinical reviews of Group Health casesPrepare clinical summaries and potential calls to treating...

Job Title: Clinical Review SpecialistDane Street is seeking a skilled Clinical Review Specialist to conduct Group Health reviews. This role involves a clinical summary, potential calls to treating providers, and responses to questions posed.Key Responsibilities:Conduct thorough clinical reviews of patient casesCommunicate with treating providers to gather...

Key Responsibilities:As a Clinical Review Specialist at Infojini, you will utilize your clinical knowledge to review medical charts for accuracy and sequencing of diagnosis. This involves analyzing Consultation reports, History and Physical reports, Operative reports, Progress reports, and Discharge reports, including complex cases. Required Skills: Epic...

Job Title: Registered Nurse Clinical ReviewerGreenlife Healthcare Staffing is seeking a skilled Registered Nurse Clinical Reviewer to join our team.Job Summary:We are looking for a highly motivated and detail-oriented Registered Nurse Clinical Reviewer to conduct utilization reviews, quality and clinical study data collection reviews, and provide technical...

Job SummaryWe are seeking a highly skilled Clinical Pharmacist to join our team as a UM Reviewer. As a key member of our Utilization Management team, you will be responsible for reviewing and approving medication requests, ensuring compliance with regulatory requirements, and developing clinical criteria and medical policies.Key ResponsibilitiesReview and...

Job Title: Physician Reviewer - Clinical Summary SpecialistAbout the Role:Dane Street is seeking skilled Physician Reviewers to conduct Group Health reviews. As a Clinical Summary Specialist, you will be responsible for creating a comprehensive clinical summary, identifying potential calls to treating providers, and responding to questions posed.Key...

Dane Street, a certified "Great Place to Work" company, is seeking a Physician to provide utilization review services for the Group Health Department.This role requires utilizing clinical expertise to review medical records and provide an interpretation of the medical appropriateness of services in compliance with state regulations, nationally recognized...

Job OverviewMedReview is seeking a highly motivated and experienced Registered Nurse Auditor to join our Hospital Bill Review Department. As a key member of our team, you will be responsible for performing bill reviews and chart validations to ensure accuracy and accountability in healthcare payment integrity.Key ResponsibilitiesConduct thorough bill reviews...

This telework opportunity at Dane Street provides the ability to customize your schedule and caseload within the week while maintaining client-mandated turnaround times.Our reviewers are compensated on a per-case basis as a 1099 independent contractor.Preferred candidates will hold a NY License, and be NY WC Board Certified.JOB SUMMARYAs a Clinical Review...

Job Title: Clinical Auditor - Hospital Bill ReviewsMedReview LLC is seeking a highly motivated and experienced Registered Nurse to join our Hospital Bill Review Department as a Clinical Auditor. In this role, you will be responsible for performing bill reviews and chart validations to ensure accuracy and accountability in healthcare.Key...

Job SummaryWe are seeking a highly skilled Staff Dentist to join our team at Liberty Dental Plan. As a Staff Dentist, you will play a critical role in ensuring the timely oral health decision-making and adjudication of dental claims and prospective requests for dental services across all lines of business.Key ResponsibilitiesConduct clinical review of claims...

Job SummaryHealth First is seeking a skilled Clinical UM Pharmacist to join our team. As a key member of our Utilization Management department, you will play a critical role in ensuring the efficient and effective review of medication requests.Key Responsibilities Monitor and review prior authorization requests for medications to ensure compliance with...

Clinical Quality Reviewer Job DescriptionInnova Solutions is seeking a highly skilled Clinical Quality Reviewer to join our team. As a Clinical Quality Reviewer, you will be responsible for assessing and auditing medical charts for compliance with HEDIS, QARR, Medicare Advantage Star measures, and quality improvement activities.Key Responsibilities:Maintain...

VNS Health is seeking a skilled Clinical Review Nurse to join their team. As a Utilization Review RN, you will be responsible for conducting clinical assessments, including medication reconciliations and post-discharge transitions of care assessment. You will also collaborate with programs to ensure compliance with regulatory requirements, lead and...

Medix Healthcare is seeking a skilled Clinical Review Nurse to join their team in New Hyde Park, NY. As a Clinical Review Nurse, you will be responsible for conducting thorough reviews of medical records to ensure accurate and timely determinations. You will work closely with Medical Review Analysts and Physician Consultants to ensure a seamless process. Key...

Job SummaryNew York State Psychiatric Institute is seeking a Utilization Review Coordinator to analyze and evaluate the quality, effectiveness, and efficiency of psychiatric and medical services provided to individuals diagnosed with mental illness.Candidates from outside or within State Service can apply for this position under the Hiring for Emergency...

Job OverviewWe are seeking a highly skilled Dental Hygienist Reviewer to join our team at Greenlife Healthcare Staffing.The ideal candidate will have a minimum of 2 years of experience in clinical services or quality improvement/utilization reviews, with a strong background in pediatrics.The successful candidate will be responsible for reviewing patient...

Job Title: Utilization Review CoordinatorNew York State Psychiatric Institute is seeking a Utilization Review Coordinator to analyze and evaluate the quality, effectiveness, and efficiency of psychiatric and medical services provided to individuals diagnosed with mental illness.Key Responsibilities:Review clinical records for completeness and accuracy to...

Medical Review SpecialistWe are seeking a highly skilled Medical Review Specialist to join our team at Concentra. As a Medical Review Specialist, you will be responsible for reviewing medical files and providing recommendations for utilization review, chart reviews, medical necessity, and appropriateness of care.Key Responsibilities:Reviews medical files and...