medical reviewer jobs in Cuyahoga County, OH

JOB DESCRIPTIONJob SummaryProvides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care.ESSENTIAL JOB DUTIES:+ Facilitates clinical/medical...

Medical Network Medical Reviewer (Freelance) We're building a stronger, healthier world. At RVO Health, we're committed to providing every individual with clear, credible, evidence-based health and wellness information that's distinguished by its compassion for the human experience. RVO Health includes prestigious digital sites such as Healthline, Greatist, Medical News Today, PsychCentral,...

Location: Anywhere in CountryAt EY, we're all in to shape your future with confidence.We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world.Handling multi-state sales/use tax recovery projects for large, sophisticated organizations takes more than just a technical understanding...

Emergency NP / VA Reviewer - Remote Greenlife Healthcare Staffing is currently seeking an Emergency Nurse Practitioner - VA Reviewer to fill an opening with a Non-profit organization. Responsibilities of the Emergency NP / VA Reviewer: - Audits/ Facility Requested: - Quality Management Reviews - Standardized set of questions - Was the standard of care timely and appropriate? - Approx. 1 hr....

Location: Anywhere in CountryHandling multi-state sales/use tax recovery projects for large, sophisticated organizations takes more than just a technical understanding of current sales and use tax rules. As a Sales and Use Tax Manager, assigned to EY’s Sales and Use Tax Lookback Review Center of Excellence (COE), we’ll look to you to build and apply your knowledge on a wide range of sales and use...

Job Type Full-time, Temporary Description Since 1982, over 160,000 youth have been helped with Youth Opportunities Unlimited (Y.O.U.) programs. Y.O.U. helps teens and young adults, ages 14-24 living in economically distressed communities succeed by providing educational and workforce opportunities, skills development, and access to career pathways. We offer school-based and community-based...

Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support quality prescribing and improve patient outcomes. This role is ideal for pharmacists who enjoy analyzing medication use, applying clinical guidelines, and collaborating with providers to promote safe,...

Location: METROHEALTH MEDICAL CENTERBiweekly Hours: 80.00Shift: Days; Rotating Weekends and HolidaysThe MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The...

Job Title: Physician ReviewerLocation: Illinois, Montana, New Mexico, Oklahoma or Texas.Job Type: ContractExpected hours per week (must include “per week”): 40 hours per weekSchedule (include days, hours, onsite/hybrid or remote): Monday – Friday, RemotePay Range (must include “per hour”): $120.19 per hourRole OverviewEvaluates clinical service requests from members and providers using clinical...

Job DescriptionUtilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy of admission, treatment, and length of stay and interfaces with managed care organizations, external reviewers and other payers. UR advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional...

Working under limited supervision, the Associate Director, Research Compliance provides leadership, coordination and technical expertise for university research compliance programs and committees, which includes the Case Western Reserve University Hu Director, Associate, University, Compliance, Research, Medical

Description Position: Director of Palliative Care UHMG/UHCMC Clinical Department: Division of Geriatrics and Palliative Care The Director of Palliative Care oversees the clinical, operational and administrative activities of the palliative care program to ensure the delivery of high quality care in a compassionate, efficient and cost effective manner. The Director will engage in the...

What Clinical Services contributes to Cardinal HealthClinical Care Delivery provides high quality, patient-centered care focused on diagnosing, treating and managing care while ensuring the safety, efficiency and effectiveness of the practice.This position requires travel between Urology Partners locations at Fairview Hospital in Cleveland and Westlake, Ohio. Schedules will be made a month in...

A healthcare company is seeking a Plan Performance Medical Director to lead clinical and operational activities while working virtually full-time from Ohio. Candidates need an MD or DO with board certification, an active medical license, and at least 10 years of clinical experience. This position involves conducting peer reviews and policy development to enhance patient care quality. The...

- Center Medical Directors desired to work 4-6 hours per week - Work as an Independent Contractor with great hourly compensation - Compensation range$150+hourly - Completely flexible schedule - Can work on Saturday or Sunday if desired - Opportunity to do additional Lab Director work as well - One of the nation's largestcollectors/suppliers of blood-plasma derived therapies - No previous plasma...

A healthcare services provider is seeking a Clinical Reviewer in Cleveland, OH. The role involves clinical and medical reviews of claims to ensure compliance with regulations, quality, and accuracy. Applicants must possess an active RN license and 2 years of clinical nursing experience. Job responsibilities include facilitating clinical reviews and resolving escalated complaints. This position...

Location: Anywhere in CountryAt EY, we're all in to shape your future with confidence.We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world.Handling multi-state sales/use tax recovery projects for large, sophisticated organizations takes more than just a technical understanding...

A healthcare organization in Cleveland is seeking a Clinical Support Registered Nurse to ensure compliance with clinical guidelines and provide member services. Responsibilities include analyzing service requests, conducting prior authorizations, and collaborating with teams for optimal member outcomes. Requires active RN license and at least 2 years of healthcare experience. Offers competitive...

JOB DESCRIPTIONProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and...

JOB DESCRIPTIONJOB SUMMARY:Provides support for coordination of benefits review activities that directly impact medical expenses and premium reimbursement. Responsible for primarily coordinating benefits with other carriers responsible for payment. Facilitates administrative support, data entry, and accurate maintenance of other insurance records.ESSENTIAL JOB DUTIES:+ Provides telephone,...