Clinical Nurse Reviewer - NIPR (Hybrid - North Quincy, MA). Under the general direction of the NIPR Manager or designee, Clinical Reviewer Auditor is tasked with the responsibility to perform and oversee retrospective, post-payment case reviews of community-based providers who participate in MassHea...
The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines and rules, evidence based clinical criteria plan, and policy exclusions. ...
Under the general direction of the NIPR Manager or designee, Clinical Reviewer Auditor is tasked with the responsibility to perform and oversee retrospective, post-payment case reviews of community-based providers who participate in MassHealth. The Clinical Reviewer Auditor works within specific gui...
Utilization Review or Utilization Management Nursing background is highly preferred.Coordinates the review process for services requiring prior authorization by company.This includes matching the coverage request to the Medical Necessity Guidelines/Interqual Criteria or Plan Benefit Documents, docum...
Possession of an active, unrestricted, and unencumbered Certified Site Reviewer Certificate issued from DHCS or participating Medi-Cal Managed Health Plan Provider. ...
Under the direction of the Nurse Director of the BWPO's South Shore Endoscopy Center (SSEC), the Registered Nurse GI Case Reviewer will work as a critical member of the procedural care team to support the quality, efficiency and satisfaction of care taking place at the SSEC. ...
What You’ll Be Doing:As a Vascular Surgery , Physician Clinical Reviewer you will be a key member of the utilization management team. What You Will Be Doing:Serve as the specialty match reviewer in Vascular Surgery cases, that do not initially meet the applicable medical necessity guidelines, as wel...
Click on Learn more about this agency button below to view Eligibilities being considered and other IMPORTANT information.WHERE CAN I FIND OUT MORE ABOUT OTHER IRS CAREERS? Visit us on the web at www.Added additional cut off of 3/15/2024.Adding additional Specialty areas: Whistleblower Office Case D...
Physician Clinical Reviewer, MRx - Oncology - REMOTE. Routinely interacts with physicians, leadership and management staff, other Physician Clinical Reviewers (PCR), and health plan members and staff whenever a physician`s input is needed or required. Reviews all cases in which clinical determinatio...
Within the Finance Department, the Financial Review is a dedicated and independent function in charge of permanent controls on accounting and financial information.The Financial Review is a key component of the Enterprise Risk Management framework.As part of the second line of defense, it consists o...
Nurse Reviewer, Endoscopy -Braintree-(3288945). Under the direction of the Nurse Director of the BWPO’s South Shore Endoscopy Center (SSEC), the Registered Nurse GI Case Reviewer will work as a critical member of the procedural care team to support the quality, efficiency and satisfaction of care ta...
Under the general direction of the NIPR Manager or designee, Clinical Reviewer Auditor is tasked with the responsibility to perform and oversee retrospective, post-payment case reviews of community-based providers who participate in MassHealth. The Clinical Reviewer Auditor works within specific gui...
Remote position but will be required to go on site as needed.Coordinates the review process for services requiring prior authorization by .This includes matching the coverage request to the Medical Necessity Guidelines/Interqual Criteria or Plan Benefit Documents, documentation of the coverage deter...
Under the general direction of the NIPR Manager or designee, Clinical Reviewer Auditor is tasked with the responsibility to perform and oversee retrospective, post-payment case reviews of community-based providers who participate in MassHealth. The Clinical Reviewer Auditor works within specific gui...
Third Party Reviewer-(3293531). The Reviewer functions under the general supervision of the Unit Manager. ...
Nurse Reviewer, Endoscopy -Braintree-(3288945). Under the direction of the Nurse Director of the BWPO’s South Shore Endoscopy Center (SSEC), the Registered Nurse GI Case Reviewer will work as a critical member of the procedural care team to support the quality, efficiency and satisfaction of care ta...
As a trusted global transformation partner, Welocalize accelerates the global business journey by enabling brands and companies to reach, engage, and grow international audiences.Welocalize delivers multilingual content transformation services in translation, localization, and adaptation for over 25...
Subject Expert Reviewer needed. ...
Remote/work-from-home opportunity, reviewers must reside in one of the following states: Illinois, Virginia, Maryland, Massachussetts, or DC . ...
Why This Role is Important to Us.Reporting to the VP Quality & Controls Assurance, the incumbent is responsible for independent quality reviews of medical claims, and evaluating Call Center activities for compliance with policies and Standard Operating Procedures (SOP).Additionally, this role will r...
NECO has an exciting opportunity in our Commonwealth Clinic for a Patient Billing and Claims Reviewer. The Patient Billing and Claims Reviewer (On-Site) will be located at 930 Commonwealth Avenue in our Commonwealth clinic. Patient Billing and Claims Reviewer (On-Site) Responsibilities:. Patient Bil...
The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines and rules, evidence based clinical criteria plan, and policy exclusions. ...
The Reviewer functions under the general supervision of the Unit Manager. ...
We have an ongoing need for document reviewers. Remote/work from home opportunity, reviewers must reside in one of the following states: Illinois, Massachusetts, Maryland, or Virginia . ...
Pittsburgh, Pennsylvania; Massachusetts; Delaware; Florida; Remote ....