Utilization Review Physician Expert Medical Necessity & Compliance
Dane Street
A leading healthcare provider in the United States is seeking a Physician to provide utilization review services. The successful candidate will utilize clinical expertise to review medical records and ensure compliance with guidelines. This role includes reviewing prior authorizations and appeals, maintaining proper licensure, and tackling QA issues. Ideal candidates will have a minimum of five years of postgraduate experience and strong communication skills. We offer generous Paid Time Off, an excellent benefits package, and a competitive salary. #J-18808-Ljbffr
- ...Santa Barbara Cottage Hospital is hiring a Utilization Review Nurse for a remote position. The role involves gathering clinical information, certifying medical necessity, and making decisions on treatment certifications. Ideal candidates will have a strong nursing background...MedicalRemote work
- ...Job Posting: Medical Director – Utilization Management (Remote) Position... ...care quality, compliance, and operational strateg... ...structural balance many physicians look for when... ...-quality, compliant review processe s.Conduct utilization... ...reviews for medical necessity, appropriateness of...MedicalFull timeContract workRemote work
$150 - $170 per hour
...CareCentrix is seeking a Part-Time Physician Reviewer to conduct utilization reviews, ensuring medical necessity across various services. This role involves collaboration with internal staff and healthcare providers to support evidence-based care decisions. The ideal candidate...MedicalHourly payPart timeFlexible hoursWeekday work- ...IntePros is seeking a Physician Reviewer to provide remote support for a healthcare organization. The role involves reviewing medical necessity determinations and applying InterQual criteria... ...opportunities to leverage clinical expertise in utilization management. #J-18808-Ljbffr...MedicalRemote work
- ...recognized Independent Review Organization (IRO), is... ...its panel of Physician Reviewers. We are currently... ...with an active New York medical license and Workers’ Compensation... ...to conduct Utilization Reviews. This is a fully... ...on the medical necessity of treatment requests...MedicalPrice workExtra incomeFor contractorsRemote workFlexible hours
- ...seeking a full-time State Licensed Pain Management Physician to support its growing utilization management team. The Physician Clinical Reviewer will work in a remote environment, ensuring compliance with medical necessity guidelines while reviewing cases efficiently. Key...MedicalFull timeRemote work
- ...Work” company is seeking a Physician to provide utilization review services for the Group... ...clinical expertise to review medical records and provide an... ...appropriateness of services in compliance with state regulations,... ...and make a medical necessity determination in compliance...Medical
$1,150 - $1,450 per month
...Position: Health Insurance Expert Type: Contract... ...Responsibilities Review and evaluate AI-... ...adjudication, and medical necessity criteria. Create realistic... ...underwriting, utilization management, benefits... ...administration, or regulatory compliance. ~ Strong...MedicalHourly payContract workSummer workRemote work- ...Cherokee Federal is seeking a physician to conduct comprehensive medical evaluations for MEPS applicants in New York... ...clinical experience. The role involves reviewing medical records, performing physical exams, and ensuring compliance with relevant standards. Benefits...MedicalShift work
- ...interventions. We are a 50-state physician, registered nurse, and... ...infrastructure. Responsibilities Review clinical documentation... ...counseling Assess and determine medical necessity for genetic testing Review... ...when deemed appropriate Ensure compliance with state regulations,...MedicalContract workRemote workFlexible hours
- ...seeking a high-performing Physician Reviewer to join our Group Health division... ...timely, defensible utilization review determinations across... ...teams to ensure quality and compliance Reviews may be conducted within... ...Active, unrestricted medical license Prior utilization review...MedicalFull timeTemporary workWork at officeRemote workWork from homeMonday to FridayNight shift
- ...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 board certification and unrestricted medical license in relevant states. The role involves performing detailed...MedicalFull timeRemote workWork from home
- ...A leading independent review organization is seeking a Utilization Management Physician Reviewer for a full-time remote role.... ...must possess an active Nebraska medical license and have a minimum of... ...other stakeholders, and ensuring compliance with medical guidelines. The...MedicalFull timeCasual workRemote workMonday to Friday
- A healthcare staffing agency seeks a Utilization Management RN to evaluate clinical conditions through medical record reviews. The position is remote, requiring candidates to... ...involve applying criteria for medical necessity, collaborating with providers, and managing...MedicalRemote work
$67.7k
...A specialized consulting firm is seeking a Medical Claims Reviewer to conduct medical reviews and provide guidance on claims. This remote role requires an active RN license, a bachelor's degree in nursing, and at least five years of clinical experience. Ideal candidates...MedicalFull timeRemote workMonday to Friday- ...Jersey, is seeking Board Certified Physicians for a telecommute role. This... ...customize your schedule and will involve reviewing health claims to ensure compliance with policies and guidelines.... ...Key responsibilities include making medical interpretations for claims, maintaining...MedicalRemote work
- ...Georgia Health System is looking for a Physician Advisor as part of their Revenue Cycle team... ...This position requires an unrestricted medical license and entails significant... ...responsibilities in optimizing healthcare service utilization. The role includes working closely with...Medical
$35 - $45 per hour
...IntePros is seeking a Remote Utilization Review Nurse serves as a key... ...patients’ needs while ensuring compliance with federal, state, and... ...to the Utilization Review Physician Advisor for further... ...Milliman Care Guidelines, and medical necessity requirements. Provide feedback...MedicalContract workRemote workWeekend work- The role offers innovative consulting solutions and a chance to work remotely. Candidates who are detail-oriented and passionate about medical review are encouraged to apply. #J-18808-Ljbffr Broadway Ventures LLCMedicalRemote job
$211.2k - $277.2k
...'re Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar... ...You will determine the medical appropriateness of inpatient... ...treatment based on medical necessity criteria and evidence-based research. Compliance with all applicable laws and...MedicalFull timeLocal areaRemote workWork from homeHome officeWeekend work- ...Dane Street, LLC is expanding its physician panel and is looking for Physician Reviewers/Advisors to provide telework services. This opportunity allows for... ...maintaining schedule flexibility. The reviewer will assess medical records for disability claims and provide...MedicalExtra incomeRemote work
- ...is expanding our physician panel! This is a... ...independent contract reviewers (1099)... ...cases, reviews all medical records, and addresses... ...each question posed utilizing client-specific... ...practice with medical necessity and utilization... ...as an expert in Independent Medical...MedicalExtra incomeContract workRemote work
- ...health and social services, is hiring a Physician, Medical Document Review. This pivotal role focuses on... ...Reassessments to ensure accuracy and compliance. Finalize Wellness Plan dispositions... ...that uphold program standards. Utilize software systems such as SEAMS, EPIC...MedicalWork at officeRemote workFlexible hours
- A leading Independent Review Organization is seeking Board-Certified Psychiatrists with a New York medical license for a fully remote opportunity. This role involves conducting medical necessity reviews, allowing you to maintain your active practice while enjoying flexibility...MedicalRemote work
- ...provider located in Georgia is seeking a Utilization Review Coordinator Per Diem to manage the utilization review process and ensure compliance with health care regulations.... ...competitive compensation, benefits including medical plans, and a challenging work environment...MedicalDaily paid
- ...advisory firm is seeking an Oral Surgery Independent Medical Examiner to review medical records for insurance appeals. This entry... ...and flexible scheduling, focusing on providing expert advisory opinions on medical necessity without establishing doctor-patient relationships...MedicalContract workRemote workFlexible hours
$50 per hour
...communication skills and a strong background in utilization management. The position is remote and... ...position, you will be responsible for reviewing and processing appeals, performing necessary medical reviews, and maintaining compliance with relevant standards. Strong problem...MedicalTemporary workRemote work- ...A healthcare solutions company is seeking a Utilization Management Nurse Reviewer to assess the appropriateness of medical services and collaborate with healthcare professionals. This role requires a Licensed Practical/Vocational Nurse with clinical experience and skills...Medical
- ...community hospital in Arizona is seeking a Utilization Management Nurse to ensure healthcare... ...and quality through diligent review of medical records and adept communication. You'll... ...clinical decision-making and regulatory compliance. The ideal candidate will have strong...Medical
- ...Inc ( IRI ) Title: Medical Director Location... ...’s work includes reviewing all submitted... ...scenarios, and providing expert decisioning on... ...and meets compliance timelines. Conduct... ...compliant medical necessity reviews for inpatient... ..., tools, and utilization management practices...MedicalContract workRemote work
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