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Primary reviewer of CMO Master Batch Records (MBRs) and executed batch records, and approve when delegated by the Director, Quality Assurance. The QA Specialist will have oversight of and involvement in, GMP compliance for production of Clinical Trial Material (CTM), including work performed by Contract Manufacturing Organizations (CMOs.
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Summary We are seeking a talented individual for a Nurse Reviewer who will be responsible for performing clinical reviews to determine if the medical record documentation supports the need for the service based on clinical criteria, coverage policies, and utilization and practice guidelines as defined by review methodologies specific to the contract for which services are being provided.
$58,200 - $83,200 a yearRemoteExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Our Behavioral Health UM Clinical Reviewer (RN, LCSW,LPC, and/or LBA) will use clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements, critical thinking, and decision-making skills to determine medical appropriateness while maintaining production goals and QA standards.
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Acentra seeks a Behavioral Health UM Clinical Reviewer (PRN, Remote within Virginia) with an active RN, LCSW, LPC, and/or LBA to join our growing team. Always maintain medical records confidentiality through proper use of computer passwords, maintenance of secured files, and adherence to HIPAA policies.
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Review and interpret patient records and compare against criteria to determine medical necessity and appropriateness of care; determine if the medical record documentation supports the need for services.
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Active unrestricted Registered Nurse (RN) license, Licensed Clinical Social Worker (LCSW) license, Licensed Professional Counselor (LPC) license, or Licensed Behavioral Analyst (LBA) license in the State of Virginia.
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Experience with Community Based Mental Health Services (e.g. Case Management, TDT, IIH, MHSS, IOP) CNSI and Kepro are now Acentra Health! Knowledge of current National Committee for Quality Assurance (NCQA)/Utilization Review Accreditation Committee (URAC) standards.
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1+ year of Utilization Review (UR) and/or Prior Authorization or related work experience. Ensures day-to-day processes are conducted in accordance with NCQA, URAC, and other regulatory standards. Experience with Substance Use (ARTS.
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Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Foster positive and professional relationships and liaise with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
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Think of it as an open invitation to embrace the company’s mission, actively engage in problem-solving, and take ownership of your work daily. Experience with Applied Behavioral Analysis (ABA) Determine approval or initiate a referral to the physician consultant and process physician consultant decisions, ensuring the reason for the denial is described in sufficient detail in correspondence.
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We are seeking a highly skilled and detail-oriented Batch Record Reviewer to join our Cell & Gene Manufacturing facility in Maryland, USA. In this role, you will be responsible for meticulously reviewing batch records to ensure accuracy, compliance, and adherence to regulatory standards.
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Our mission is to innovate health solutions that deliver maximum value and impact. Based on our compensation philosophy, an applicant’s placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.
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As Physician Reviewer/Advisor for Disability Peer Review, you will utilize clinical expertise to review medical records provided and return an independent, professional opinion on the clamants functionality and restrictions or limitations as it relates to an application for disability benefits or the current status of disability.
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Reviews all medical records and addresses each question posed by the client utilizing client-specific criteria or other nationally recognized evidence-based criteria. Candidates must be an Orthopedic Surgeon inthe Dallas or Houston area and hold a TX License, with testimony/deposition/counter affidavit work experience.
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EzURs affords our clients true nationwide physician reviewer coverage. Objective, Defensible, Evidenced-based assessment of the medical records focusing on diagnosis, mechanism of injury, current and past treatment rgimes allowing them to assess the appropriateness of care in a non-bias fashion.
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