. Candidates must have a NJ license. JOB SUMMARY: Relying on clinical background, reviews health claims providing medical.... Responsibilities: MAJOR DUTIES AND RESPONSIBILITIES: Reviews medical files and provides recommendations for utilization review...

with agency staff, and performs related work as required. Reviews appeals and, when possible, obtains additional evidence... within a timeframe that is reasonable and attains the DOL guidelines for promptness. Reviews cases prior to and after the hearing...

. Candidates must have a NM license. Spine Surgeon JOB SUMMARY: Relying on clinical background, reviews health claims... regulations Responsibilities: MAJOR DUTIES AND RESPONSIBILITIES: Reviews medical files and provides recommendations...

. JOB SUMMARY: Relying on clinical background, reviews health claims providing medical interpretation and decisions about the... AND RESPONSIBILITIES: Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity...

of appeals including tracking and facilitating of physician reviews. The Director of Utilization Management is responsible...

. Candidates must have a CA license. JOB SUMMARY: Relying on clinical background, reviews health claims providing medical... Responsibilities: MAJOR DUTIES AND RESPONSIBILITIES: Reviews medical files and provides recommendations for utilization review, chart...

and their families. What You'll Do: Conduct independent, remote case reviews evaluating medical necessity, appropriateness...

. JOB SUMMARY: Relying on clinical background, reviews health claims providing medical interpretation and decisions about the... AND RESPONSIBILITIES: Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity...

. Candidates must have a MS license. JOB SUMMARY: Relying on clinical background, reviews health claims providing medical... Responsibilities: MAJOR DUTIES AND RESPONSIBILITIES: Reviews medical files and provides recommendations for utilization review, chart...

. Candidates must have a CA license. JOB SUMMARY: Relying on clinical background, reviews health claims providing medical... Responsibilities: MAJOR DUTIES AND RESPONSIBILITIES: Reviews medical files and provides recommendations for utilization review, chart...

on a per case basis as a 1099 independent contractor. JOB SUMMARY: Relying on clinical background, reviews health claims... regulations. Responsibilities: MAJOR DUTIES AND RESPONSIBILITIES: Reviews medical files and provides recommendations...

. JOB SUMMARY: Relying on clinical background, reviews health claims providing medical interpretation and decisions about the.... Responsibilities: MAJOR DUTIES AND RESPONSIBILITIES: Reviews medical files and provides recommendations for utilization review, chart...

services. The role includes conducting concurrent and retrospective chart reviews to evaluate medical necessity, support...

mechanisms for all cases. Review and execute ad hoc requests, quality reviews, and/or focused audits, as needed. Escalate... recommendations based on clinical case reviews Ability to demonstrate critical thinking, strong problem-solving capability. Strong...

services. The role includes conducting concurrent and retrospective chart reviews to evaluate medical necessity, support...

. Candidates must have a NM license. JOB SUMMARY: Relying on clinical background, reviews health claims providing medical... Responsibilities: MAJOR DUTIES AND RESPONSIBILITIES: Reviews medical files and provides recommendations for utilization review...

on a per case basis as a 1099 independent contractor. JOB SUMMARY: Relying on clinical background, reviews health claims... regulations. Responsibilities: MAJOR DUTIES AND RESPONSIBILITIES: Reviews medical files and provides recommendations...

of appeals including tracking and facilitating of physician reviews. The Director of Utilization Management is responsible...

our global risk reviews. Who you are 4+ years experience in Customer Due Diligence/Enhanced Due Diligence/KYC...

and their families. What You'll Do: Conduct independent, remote case reviews evaluating medical necessity, appropriateness, or quality... complexity Most cases take 1-3 hours to complete; shorter reviews may take less than 1 hour Strong written communication skills...