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In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education.

HOUR

Acentra Health

Clinical Reviewer

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FULL_TIME

OTHER

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. The goal of Iowa PASRR is to protect vulnerable populations by confirming nursing facility placement is appropriate, identifying specialized services, and promoting opportunities for individuals to live in the least restrictive and most supportive environment possible.

MAXIMUS provides business services to help governments operate health and human services programs, mostly at the state and national levels. The company's health services segment offers outsourced program management and administrative services,

Maximus

Clinical Reviewer (Remote)

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Minimum/Special/Additional Requirements: BEHAVIORAL HEALTH POSITIONS: Requires a four (4) year degree in a human services field (such as psychology, behavioral or mental health, special education, social work) and five (5) years utilizing the required knowledge, skills, and abilities and associated with such positions as clinician, counselor, therapist, social worker, psychologist or psychiatric nurse OR any combination of education (above the high school level) and/or experience equivalent to nine (9) years in fields utilizing the required knowledge, skills, and abilities associated with such positions. Additionally, the role provides ongoing clinical guidance, oversight, and training to PSR staff to build competencies and maintain strict adherence to Medicaid, CARF, and licensing regulations, while actively collaborating with the program supervisor on staff development, supervision, and resource management.

Abacus Solution Group

Clinician III- Clinical Records Reviewer - 43426

Crelate

Knowledge of the continuum of services and support necessary to support the behavioral health/substance abuse treatment needs of individuals, including community-based, inpatient, and long-term care services and supports. This position collaborates with interdisciplinary teams to achieve system wide patient safety outcomes related to behavioral health, developmental services, and physical health care, and may also assist with development of quality improvement activities.

DHRM

Clinical Nurse Reviewer

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YEAR

Commonwealth of Virginia

Conduct the highest-complexity and escalated clinical medical reviews, including reassigned cases where the original reviewer is no longer available, consistent with SOW continuity requirements for Discussion & Education sessions. The Senior Nurse Reviewer performs complex medical record reviews of Medicare Part A/B and DMEPOS claims that require clinical judgment in order to assess the potential for overpayment or fraud.

DOMA Technologies

Sr. Nurse Reviewer (Medicare)

The Nurse Reviewer performs complex medical record reviews of Medicare Part A/B and DMEPOS claims that require clinical judgment in order to assess the potential for overpayment or fraud. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care.

Nurse Reviewer (Medicare)

Essential Knowledge: 2 or more years of relevant experience performing complex coding; quality assurance, training, appeals, and/or auditing services involving ICD-10-CM/PCS, CPT/HCPCS, DRG/APRDRG, and/or other coding, classification, and/or payment systems pertinent in the healthcare industry, including but not limited to, State of Maryland, in particular. Subject matter expert in clinical documentation review, clinical data abstraction, clinical coding, auditing, and variables impacting payment methodologies that are based in medical record documentation.

IDR Coder Reviewer

Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an “excluded person” by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.

Evolent

Otolaryngologist-Physician Reviewer-Radiology (Full-Time)

IRecruitee

Endocrinology-Physician Reviewer-Radiology (Full-Time)

Mentors Behavioral Health Care Management staff by assisting in training, attending utilization management rounds, and serving on interdepartmental initiatives; assists in developing a program around psychological and neuropsychological testing. D in clinical/counseling psychology and managed care experience which includes experience with the administration and interpretation of psychological test batteries; or any combination of education and experience, which would provide an equivalent background.

Elevance Health Inc

Psychologist Reviewer - ABA

Your main task will be to evaluate medical records, provide clinical summaries, engage in peer communications, and answer specific questions posed by our clients. Your expertise is vital to helping us deliver high-quality healthcare assessments.

Dane Street

Board Certified Physician Reviewers - Medical Oncology - VA Licensed

Elevance Health

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The Coordinator provides clinical leadership, advises strategic direction, develops quality improvement strategies, enhances program components, provides patient education, and develops patient support mechanisms and post-operative follow-up. Provide updates for bariatric resource manuals to CRMC/CRMG staff and maintain a positive working relationship with Clinical Nurse Educators to provide annual in-service education as needed.

Chesapeake Regional Healthcare

Bariatric Program Coordinator

While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Uses Technical and Functional Experience: Possesses up to date knowledge of the profession and industry; is regarded as an expert in the technical/functional area; accesses and uses other expert resources when appropriate.

Clinical Reviewer Jobs in Virginia

Clinical Reviewer Acentra Health

Clinical Reviewer (Remote) Maximus

Clinician III- Clinical Records Reviewer - 43426 Abacus Solution Group

Clinical Nurse Reviewer DHRM

Clinical Nurse Reviewer Commonwealth of Virginia

Sr. Nurse Reviewer (Medicare) DOMA Technologies

Nurse Reviewer (Medicare) DOMA Technologies

IDR Coder Reviewer DOMA Technologies

Otolaryngologist-Physician Reviewer-Radiology (Full-Time) Evolent

Endocrinology-Physician Reviewer-Radiology (Full-Time) Evolent

Psychologist Reviewer - ABA Elevance Health Inc

Board Certified Physician Reviewers - Medical Oncology - VA Licensed Dane Street

Psychologist Reviewer - ABA Elevance Health

Bariatric Program Coordinator Chesapeake Regional Healthcare

PBR Blue Ridge Cancer Care

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