Clinical Reviewer

Nurse Reviewer - Fraud, Waste, and Abuse Clinical ReviewsThe Nurse Reviewer - FWA Clinical Reviews is a critical role within our organization, responsible for conducting thorough clinical reviews to identify, investigate, and prevent healthcare fraud, waste, and abuse.Key Responsibilities:Conduct in-depth clinical reviews of medical records, claims data, and...

Job SummaryUnder general supervision and following established policies, procedures, and professional guidelines, the Medical Auditor performs medical record reviews to establish the accuracy of patient billing and to monitor departmental compliance with charge policies. Identifies and recommends corrective actions to departmental Directors when repeated...

Job SummaryWe are seeking a skilled Licensed Utilization Review professional to join our team at Elevance Health. As a key member of our healthcare team, you will play a critical role in ensuring the appropriate and consistent administration of plan benefits.Key ResponsibilitiesCollaborate with healthcare providers to collect clinical information required...

Job Title: Licensed Utilization Review LeadAt Elevance Health, we are seeking a highly skilled Licensed Utilization Review Lead to join our team. As a key member of our healthcare team, you will play a critical role in ensuring that our members receive the highest quality care while maintaining cost-effectiveness.Job Summary:The Licensed Utilization Review...

Job SummaryWe are seeking a highly skilled Licensed Utilization Review II to join our team at Elevance Health. As a key member of our medical management team, you will play a critical role in ensuring the appropriate and consistent administration of plan benefits.Key ResponsibilitiesWork with healthcare providers to collect clinical information required for...

Job SummaryWe are seeking a skilled Licensed Utilization Review II to join our team at Elevance Health. As a key member of our clinical review team, you will play a critical role in ensuring the appropriate and consistent administration of plan benefits.Key ResponsibilitiesConduct pre-certification, inpatient, retrospective, out-of-network, and...

About the RoleWe are seeking a skilled Licensed Utilization Review II to join our team at Elevance Health. As a key member of our healthcare team, you will play a critical role in ensuring the appropriate and consistent administration of plan benefits.Key ResponsibilitiesCollaborate with healthcare providers to collect clinical information required for...

Radiation Oncology Preservice Review Nurse RNAt UnitedHealth Group, we're committed to helping people live healthier lives and making the health system work better for everyone. As a Radiation Oncology Preservice Review Nurse RN, you'll play a critical role in ensuring that patients receive the best possible care.Key Responsibilities:Determine the...

About the RoleWe are seeking a highly skilled and experienced Clinical Scholar to join our team at AdventHealth Tampa. As a Clinical Scholar, you will play a vital role in the supervision and instruction of Nursing students in the clinical (acute care) area.Key ResponsibilitiesDevelop, design, and deliver instruction in clinical courses in collaboration with...

About the RoleThe Clinical Solutions Manager is a key position at Apixio, responsible for the development and management of our clinical solutions, including MS and APR-DRG validation. This role requires expertise in healthcare payment methodologies and audit and review criteria to target key claims for review and recovery.Key ResponsibilitiesInventory and...

{"Job Title": "Clinical Pharmacist", "Job Description": "Job SummaryWe are seeking a highly skilled Clinical Pharmacist to join our team at Axelon. As a Clinical Pharmacist, you will play a critical role in ensuring the safe and effective use of medications for our patients.Key ResponsibilitiesReview and interpret physician orders to prepare...

Position Overview: The Pharmacy operates within a health center framework, dedicated to providing comprehensive health services. The Part-Time Clinical Pharmacist will oversee and engage in pharmacy operations, focusing primarily on the dispensing of medications, quality assurance, and clinical oversight. This health center offers a wide range of medical...

Surgery Coordinator Job SummaryThis is a fast-paced, multi-tasking position that requires strong organizational and communication skills. The successful candidate will be responsible for scheduling surgeries, managing provider schedules, and coordinating with athletic trainers and other healthcare professionals.Key Responsibilities:Completes daily tasks and...

Job SummaryThe ASN Clinical Assistant plays a crucial role in ensuring the quality of the student learning experience during clinical education. This position coordinates and facilitates activities on behalf of the academic program, working closely with academic and clinical Course Lead faculty.Key ResponsibilitiesFacilitate the clinical education component...

Job Title: Clinical DirectorWe are seeking an experienced Clinical Director to lead our team of medical professionals in delivering exceptional patient care and cutting-edge medical procedures.Job Summary:The ideal candidate will have a solid background in ophthalmology with specific expertise in laser eye procedures. As our Clinical Director, you will be...

Job Title: RN Case ManagerPalm Medical Centers is seeking an experienced Clinical Coordinator to join our team.Job SummaryThe Clinical Coordinator will perform a variety of tasks and coordinate the plans of care for hospital and nursing home patients, from admission to discharge, to ensure the continuation of care is provided effectively and efficiently.Key...

Job SummaryThe ASN Clinical Assistant plays a vital role in ensuring the quality of the student learning experience during clinical education. This position coordinates, facilitates, administers, and monitors activities on behalf of the academic program and in coordination with academic and clinical Course Lead faculty.Key ResponsibilitiesFacilitate the...

About the Role: The Clinical Resource Manager is a key leadership position at AdventHealth, responsible for providing clinical expertise and guidance to our facilities in the review, evaluation, and procurement of products. This role leads multi-disciplinary teams to develop consensus supply utilization programs and initiatives, reducing product variation,...

Position Overview:Oversee and manage the activities of the clinical education programGuide and support students during their practical trainingCollaborate with faculty to enhance curriculum deliveryEnsure adherence to program standards and regulationsKey Responsibilities:Monitor student interactions at clinical locationsAssist students in their...

Job SummaryThe Clinical Coordinator is a key member of the physician practice team, responsible for leading evidence-based patient care services through team education, rounding, training, and continuous safety and quality improvement.Key ResponsibilitiesFront Office Duties:Perform front office duties as needed to support patient care.Clinical...