DPT Clinical Reviewer: MSK/Ortho Utilization Review
Cohere Health
Cohere Health is seeking a Doctor of Physical Therapy (DPT) to deliver on musculoskeletal programs by reviewing clinical information and applying evidence-based guidelines. You will provide timely medical reviews and clinical determinations with a focus on quality and fast turnaround, documenting decisions in Cohere workflow tools for clear provider and member reference. The role requires a DPT from a CAPTE-accredited program, an active PT license, and 5+ years of direct clinical care. #J-18808-Ljbffr Cohere Health
$45 - $50 per hour
...Greenlife Healthcare Staffing is looking for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical studies. With a competitive pay of $45 - $5...SuggestedHourly payRemote work$122.91k - $188.02k
Healthfirst is seeking a Medical Peer Reviewer based in Pennsylvania to evaluate medical necessity as part of utilization management. The role requires collaboration with various medical departments and demands flexibility in workload. The hiring range is $122,907 to $1...Suggested- ...in New Jersey is seeking a Medical Peer Reviewer to support the CMO Administration by assessing... ...board-certified physicians, strong clinical judgment, and the ability to work within... ...time off; the team collaborates across Utilization Management, Care Management, and medical...Suggested
- ...IntePros is seeking a Physician Reviewer to provide remote support for a healthcare organization. The role involves reviewing... .... This position offers a collaborative environment with opportunities to leverage clinical expertise in utilization management. #J-18808-Ljbffr...SuggestedRemote work
- ...A leading independent review organization is seeking a Utilization Management Physician Reviewer for a full-time remote role. Candidates must possess an... ...Nebraska medical license and have a minimum of 5 years clinical practice experience. Responsibilities include conducting...SuggestedFull timeCasual workRemote workMonday to Friday
- ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active... ...with management and providing guidance on clinical questions. This is a unique opportunity to work from...Full timeRemote workWork from home
- ...A healthcare management organization is seeking experienced Physician Reviewers to join their Medicare Utilization Management team in a remote position. Responsibilities include reviewing clinical service requests, applying evidence-based guidelines, and collaborating...Remote work
- Behavioral Health Services Reviewer Are you passionate about improving access to behavioral... ...the community? Do you enjoy using your clinical expertise to evaluate needs, support... ...system; apply evidence-based criteria to utilization management reviews; document clinical determinations...Full timeContract workRemote workWork from home
$140 - $145 per hour
...Physician Reviewer (Part-Time) - Utilization Management Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management Team... ..., outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. Hours...Hourly payFull timePart timeLocal areaRemote workWork from homeHome officeWeekend work- ...Physician Reviewer Opportunity Dane Street, a nationally recognized Independent Review Organization (IRO)... ...Workers' Compensation Board Certification to conduct Utilization Reviews. This is a fully remote, non-clinical role offering supplemental income with flexible...Price workExtra incomeFor contractorsRemote workFlexible hours
- ChenMed LLC is seeking a Physician Reviewer to lead delegated utilization management (UM) reviews across multiple markets. You will establish daily case counts, attend essential calls with health plans, advise other reviewers, and participate in ongoing process and quality...Remote job
- ChenMed LLC is seeking a Physician Reviewer to lead Utilization Management (UM) cases across multiple markets. The role includes coordinating with health plans and local teams, attending daily calls, and guiding other physician reviewers in a growing delegated UM program...Local area
- ...Job Description JOB SUMMARY Reports to Team Lead, Clinical Quality and Record Review. Works independently and with other departments and/or vendors... ...delivery. RESPONSIBILITIES Clinical Review Utilizes clinical expertise to conduct clinical case retrospective...Work at officeImmediate startRemote workMonday to Friday
- ChenMed LLC seeks a physician with strong clinical and UM background to cover delegated utilization management across multiple territories. The role requires residency... ...2+ years in hospital medicine, with utilization review experience preferred. You will coordinate with PCP/...Remote job
$219k - $286.9k
Oscar Health is hiring a Physician Reviewer to join our Utilization Management team. You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. This remote role...Remote jobWork from home- Clinical Utilization Review Nurses (RN) Based In Alabama Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality improvement services for more than 50 years. We are leaders in assisting front-line...Full timeContract workRemote work
- ...reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs.... ...PST (Pacific West Coast) The Clinical Reviewer supports the WISeR Prior Authorization... ...clinical judgment within regulated utilization management or prior authorization workflows...Work at officeImmediate startRemote workMonday to FridayFlexible hoursAfternoon shift
- ...and post-payment audits of DRG coding and clinical documentation. The ideal candidate will... ...high-quality recoverable claims by reviewing medical records and other documentation... ...10-CM and ICD-10 PCS codes and MS-DRGs. Utilizing evidence-based criteria supported by current...Remote jobLive inWork from homeMonday to Friday
- ChenMed LLC is seeking a Physician Reviewer to serve as the primary physician reviewer for Utilization Management (UM) cases across multiple markets. This role includes advising other reviewers, attending health plan calls, and coordinating care with local teams to support...Local area
$80 per hour
...part-time consulting opportunity for United States-based healthcare professionals experienced in prior authorization, utilization management, clinical review, medical necessity criteria, payer authorization workflows, documentation review, and healthcare operations.This...Hourly payPart timeFor contractorsWork at officeRemote workFlexible hours- 100 LCMC Health is seeking an RN for Utilization Review to support patient throughput and physician communication while ensuring payer requirements are met. Responsibilities include care reviews, medical necessity determinations, and accurate status assignments per CMS...Shift workWeekend work
- Phoebe Putney Memorial Hospital in Albany, GA, is seeking an RN UR Specialist to manage utilization review activities, secure authorizations, and support medical necessity justification for hospital services. You will liaise with insurance payers and care management staff...Full time
$115k - $125k
...TapestryHealth is looking for a Nurse Practitioner Clinical Reviewer to oversee Remote Patient Monitoring (RPM), Behavioral Health Integration (BHI), and Chronic Care Management (CCM) reports. This remote role requires at least 5 active NP licenses and certifications,...Remote workMonday to Friday- Clinical Transcript Reviewer About Limbic Limbic is the leading clinical AI company for mental healthcare and the largest deployment of patient-facing mental health AI in the world. Our technology has supported over half a million patients across the UK and US, helping...Hourly payContract workPart timeFor contractorsRemote workFlexible hours
- Intero is seeking an experienced 2nd Level Clinical Documentation Reviewer to support a long-term client engagement. This is an advanced CDI role focused on complex case reviews, documentation quality, denial prevention, and physician education. We're looking for a highly...
$20 - $30 per hour
A behavioral healthcare organization is seeking a Utilization Review Specialist to conduct clinical auditing and negotiate authorizations. The ideal candidate has a Bachelor's degree in Social Work or Nursing and 1-2 years of healthcare experience. Responsibilities include...- ...Hmong Chinese Language Document Reviewer Employment Type: Full Time, Mid-Level Department: Legal As a CGS Hmong Chinese Document... ...; Produces a variety of written documents and materials utilizing a wide range of office software applications; Establishes...Full timeWork at officeFlexible hours
$32 per hour
...are valued and respected. We have an ongoing need for Document Reviewers. Document Reviewers will review documents for complex... ...or Android OS version 16 or later is required. Proficiency in utilizing modern technology, especially computers and related remote work...Hourly payTemporary workRemote workWork from homeHome officeMonday to ThursdayFlexible hours$122.91k - $188.02k
...CMO Administration team, the Medical Peer Reviewer plays a critical role in consulting on medical necessity in the context of utilization management and ensuring adherence to... ...Healthfirst information and make informed clinical judgments and recommendations. The Medical...Remote jobTemporary workPart timeWork experience placementFlexible hoursWeekend work3 days per weekWeekday work- ...remote 1099 contractor role, requiring a minimum of 5 state licenses. The responsibilities include reviewing patient data, developing care plans, and communicating with clinical staff to enhance patient outcomes. Candidates must have advanced practice education and strong...Remote jobFor contractorsFlexible hours
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