Behavioral Health Utilization Management Reviewer AmeriHealth CaritasBehavioral Health Utilization Management ReviewerWashington, DCRemote$77,700–$105,900 / yearUsing clinical knowledge and experience, the clinician reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review. The BH UM Reviewer will use professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases to integrated care management as needed.
Nurse Reviewer (Medicare) DOMA TechnologiesNurse Reviewer (Medicare)VARemoteThe 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.
Clinical Documentation Specialist II Johns Hopkins HospitalClinical Documentation Specialist IIBaltimore, MDRemoteRHIT.RHIA: Requires successful completion of the academic requirements for the Registered Health Information Technician (RHIT) certification or Registered Health Information Administrator (RHIA) certification accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) and be a Certified Coding Specialist (CCS). We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.
Market Manager Monogram HealthMarket ManagerWashingtonRemoteReporting to the Market Physician Executive and matrixed to the General Manager, the Market Manager will be charged with achieving company Organizational Key Results, Key Performance Indicators, and Financial Health of the Market. The Market Manager will work closely with Regional/Market and Centralized clinical and operations Leaders to deliver quality patient care and overall patient and staff experience.