Medical Reviewer

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Clinical Review Specialist

🕒 July 14

CorroHealth

5001 - 10000

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Website
LinkedIn
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Clinical Review Specialist providing clinical review support to assist with client demand. Responsible for medical record reviews and ensuring compliance with payer guidelines.

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

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Clinical RN Chart Reviewer, CIC or CCS certified

🕒 July 10

ProgenyHealth, LLC

201 - 500

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

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Clinical RN Chart Reviewer performing clinical reviews of medical records for claims coding accuracy. Role involves auditing NICU claims and ensuring compliance with coding standards and guidelines.

🇺🇸 United States – Remote

💵 $90k - $110k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔍🏥 Medical Reviewer

Clinical Review Specialist

🕒 July 5

New England Life Care

201 - 500

🏥 Healthcare

💊 Pharmaceuticals

🤝 Non-profit

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Clinical Review Specialist conducting regular reviews for coverage in home infusion therapy company. Consulting with Medical Director, maintaining compliance, and ensuring high-quality care.

🇺🇸 United States – Remote

💵 $24 - $25 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

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Medical Review Specialist

🕒 July 2

Medlogix

201 - 500

🏥 Healthcare

💼 Consulting

📦 Logistics

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Medical Review Specialist reviewing medical bills utilizing clinical knowledge for Medlogix, a company providing medical claims solutions. Focus on quality, timeliness, and customer service for assigned accounts in a remote role.

🇺🇸 United States – Remote

💵 $48k - $55k / year

💰 Private Equity Round on 2017-06

⏰ Full Time

🟢 Junior

🔍🏥 Medical Reviewer

Medical Review Specialist

🕒 July 2

Medlogix

201 - 500

🏥 Healthcare

💼 Consulting

📦 Logistics

Website
LinkedIn
All Job Openings

Medical Review Specialist reviewing medical bills for appropriate reimbursements. Working in a remote capacity while serving clients in medical claims for auto and workers’ compensation insurance.

🇺🇸 United States – Remote

💵 $48k - $55k / year

💰 Private Equity Round on 2017-06

⏰ Full Time

🟢 Junior

🔍🏥 Medical Reviewer

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Clinical Record Reviewer at Lehigh Valley Health Network supporting quality improvement

Clinical Record Reviewer, RN

Clinical Record Reviewer at Lehigh Valley Health Network managing and supporting quality improvement of patient records. Reviewing documentation for home health and hospice care with a focus on compliance and medical necessity.

• Conducts reviews of clinical interactions and clinical documentation
• Collects data following established procedures and analyzes findings for purposes of continuous quality improvement and for internal and external reporting
• Interacts with multiple stakeholders internally and externally
• Provides clinical reviews of Quality of Care (QOC) and Critical/Adverse incidents related to clinical services
• Audits and reviews case manager and provider clinical documentation and telephone interactions against regulations, accreditation standards and contract requirements
• Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for care managers
• Evaluates level of patient safety risk and need for follow-up actions per policies
• Prepares monthly performance reports with assistance from Reporting and Analytics unit
• Presents findings at provider and customer meetings as needed
• Assists in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for providers and care managers
• Responsible for auditing as well as validating internal audit results and/or corrective action plans

Quality Clinical Reviewer auditing clinical documentation and improving quality of care

Quality Clinical Reviewer

Quality Clinical Reviewer auditing clinical documentation and reviews to enhance quality of care in healthcare settings. Collaborates with stakeholders and prepares analytical reports for continuous improvement.

• Conducts reviews of clinical interactions and clinical documentation including reviews of case management records and provider treatment records.
• Collects data following established procedures and analyzes findings for purposes of continuous quality improvement and for internal and external reporting.
• Interacts with multiple stakeholders internally and externally.
• Provides clinical reviews of Quality of Care (QOC) and Critical/Adverse incidents related to clinical services.
• Audits and reviews case manager and provider clinical documentation and telephone interactions against regulations, accreditation standards and contract requirements.
• Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for care managers.
• Evaluates level of patient safety risk and need for follow-up actions per policies.
• Collects, analyzes and prepares clinical record information for projects related to assessing the efficiency, effectiveness and quality of the delivery of managed care services.
• Prepares monthly performance reports with assistance from Reporting and Analytics unit.
• Presents findings at provider and customer meetings as needed.
• Assists in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for providers and care managers.
• Responsible for auditing as well as validating internal audit results and/or corrective action plans.

Quality Clinical Reviewer handling clinical reviews and documentation analysis

Quality Clinical Reviewer conducting clinical reviews and documentation analysis for managed care services. Interacting with stakeholders and ensuring quality of care standards are met.

• Ensure clinical documentation meets payer-specific insurance coverage criteria
• Perform comprehensive reviews of SLP evaluation reports and related clinical documentation
• Evaluate documentation for completeness, accuracy, and medical necessity
• Support the funding workflow by ensuring clinical documentation is audit-ready
• Collaborate with funding teams to resolve clinical documentation issues
• Provide clear, actionable feedback to SLPs to improve report quality
• Assist in maintaining and updating payer-specific clinical criteria checklists

Clinical Compliance Reviewer ensuring clinical documentation meets insurance coverage criteria

Clinical Compliance Reviewer

Clinical Compliance Reviewer ensuring clinical documentation meets payer-specific insurance coverage. Supporting funding workflows and providing feedback to SLPs on compliance and quality.

Medical Reviewer jobs in Pennsylvania

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Clinical Record Reviewer, RN

Quality Clinical Reviewer

Quality Clinical Reviewer

Clinical Compliance Reviewer