Search Results: 11,322 vacancies
..., VA/DC, *WA, WI & WY only)
Job Summary
Applies clinical knowledge to make determinations for pre-authorizations of specific... ...benefits. Conducts Medical / Surgical medical necessity reviews. Compiles information needed to process prior authorization requests...
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...will be filled in the following specialty areas:
Office of Appeals Case and Operations Support Policy Planning Quality & Analysis... ...training to help you grow in this position.
* Performs closed case reviews involving very large amounts of tax in dispute and the most...
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...every decision we make.
**Job Posting Title**
Physician Clinical Reviewer- GI - REMOTE
**Job Description Summary**
Key member of the... ....
+ Provides clinical rationale for standard and expedited appeals.
+ Provides assistance and act as a resource to Initial Clinical...
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...everything for our 28 million members as a clinical professional on our Medical Management/... ...written claims and authorization grievance/appeals from providers and members. Resolve all... ...complaints, grievances and appeals.
+ Review and process member and provider grievances...
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...the culture.
What You’ll Be Doing:
As a Physician Clinical Reviewer, RBM you will be a key member of the utilization management... ...+ Provides clinical rationale for standard and expedited appeals.
+ Ensures documentation of all communications with medical...
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...Job Description
Role : Appeals Project Specialist
Estimated Duration : 6+ months
Location: Phoenix, AZ (hybrid)
Position Description
Reviewing medical records and writing administrative reviews- looks at recommendations by doctors, learning Client rules...
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Grand Canyon University! One of Arizonas leading institutions of higher learning. Located in the Valley of Sun in the heart of Phoenix, Arizona, GCU is a regionally accredited, private, nondenominational Christian University. Grand Canyon University Coordinator, Compliance...
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...live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Clinical Review Pharmacist
The Clinical Staff Pharmacist is responsible for the processing and documenting of Utilization Management requests...
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...as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
The Clinical Coverage Review Medical Director is a key member of the Optum Enterprise Clinical Services Team. They are responsible for providing physician...
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...Job Description
Role: Purchase Reviewer-1153
Estimated Duration: 6+ months
Location: Phoenix, AZ
Position Description... ...referral to collections •Participate as a witness in programmatic appeals as required •Collaborate with team leads and manager to address...
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**KYC REVIEW ANALYST- OPS**
**WHAT IS THE OPPORTUNITY?**
Conduct Enhanced Due Diligence background investigations for commercial loan borrowers in adherence with credit policy and compliance with BSA and USA Patriot Act. Responsible for the quality assurance and integrity...
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...Job Description
Job Description What's the role?
Peer Reviewers execute peer reviews of CPA firms to monitor a CPA firm's accounting and auditing practice to promote quality in the accounting and auditing services provided by the firms. Both System Reviews that focus...
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...raising academic outcomes and empowering parents.
ESA Purchase Review Specialist 1
Job Location:
Empowerment Scholarship Account... ...to collections
* Participate as a witness in programmatic appeals as required
* Collaborate with team leads and manager to address...
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...the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene... ...Position Purpose: Supervise the day to day operations of the Appeals and Grievance (A&G) staff and functions within the department...
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...Responsibilities
Utilization Review (UR) Coordinator Opportunity.
Position: PRN (as needed)
This position is on-site and cannot... ...an intensive outpatient program (IOP). We also have a satellite clinic offering Intensive Outpatient Programs in the West Valley region...
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...Are you looking for a non-clinical opportunity for work/life balance needs yet want to stay... ...Director to conduct chart and peer reviews from your home office.
This is... ...meet utilization review criteria. Review appeals for denied services related to relevant...
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...Credit Review Associate
Department: Corporate
Location: Phoenix, AZ
PT/FT/Temporary : Full Time
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First International Bank and Trust is a family-owned community bank and one of Prairie Business Magazine's 50 best places to work for...
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...Christian University.
Grand Canyon University’s Academic Compliance and Regulations department is seeking a full time University Appeals Coordinator. Under supervision, this position provides departmental assistance and customer service support within the Appeals...
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...Job Title:
Sr. Credit Risk Review Officer
Location:
Scottsdale
What you'll do:
This position is responsible for planning and executing quarterly continuous credit file examination of assigned reviewable units or risk segments. The Senior Credit Risk Review...
...OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI and WY only)
Job Summary
Reviews medical documentation to determine correct coding on submitted medical and behavioral health claims utilizing appropriate clinical staff resources as needed to assist in review. Update authorizations...
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Interim role
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