Clinical Reviewer
Meridian, ID ยท On-site
Blue Cross of Idaho is seeking a Clinical Reviewer to support the Healthcare Operations initiatives to ensure the delivery of medically necessary and appropriate, cost-effective and timely, quality ...
Meridian, ID ยท On-site
Blue Cross of Idaho is seeking a Clinical Reviewer to support the Healthcare Operations initiatives to ensure the delivery of medically necessary and appropriate, cost-effective and timely, quality ...
Meridian, ID ยท On-site
Blue Cross of Idaho is seeking a Clinical Reviewer to support the Healthcare Operations initiatives to ensure the delivery of medically necessary and appropriate, cost-effective and timely, quality ...
Phoenix, AZ ยท On-site
$140 - $145/hr
Review escalated cases and render a definitive decision to agree or disagree with the original MCE denial. * Evaluate whether ASAM (American Society of Addiction Medicine) criteria were correctly and ...
Phoenix, AZ ยท On-site
$140 - $145/hr
Review escalated cases and render a definitive decision to agree or disagree with the original MCE denial. * Evaluate whether ASAM (American Society of Addiction Medicine) criteria were correctly and ...
Data Reviewer The Data Reviewer performs review of a variety of routine and complex analytical analysis experiments that are conducted on pharmaceutical and biopharmaceutical compounds with various ...
New
Data Reviewer The Data Reviewer performs review of a variety of routine and complex analytical analysis experiments that are conducted on pharmaceutical and biopharmaceutical compounds with various ...
New
Rensselaer, NY ยท On-site
Quality Control Data Reviewer III - Onsite position in Rensselaer, NY Build your future at Curia, where our work has the power to save lives Curia is a global contract development and manufacturing ...
Rensselaer, NY ยท On-site
Quality Control Data Reviewer III - Onsite position in Rensselaer, NY Build your future at Curia, where our work has the power to save lives Curia is a global contract development and manufacturing ...
Medical Data Reviewer ICON is a global healthcare intelligence and clinical research organisation united by a mission to bring new medicines and treatments to patients faster. As a values-driven ...
Medical Data Reviewer ICON is a global healthcare intelligence and clinical research organisation united by a mission to bring new medicines and treatments to patients faster. As a values-driven ...
Burlingame, CA ยท On-site
The MSO Physician Reviewer is responsible for ensuring the appropriate utilization of healthcare services while maintaining high standards of patient care. This role involves conducting evidence ...
Burlingame, CA ยท On-site
The MSO Physician Reviewer is responsible for ensuring the appropriate utilization of healthcare services while maintaining high standards of patient care. This role involves conducting evidence ...
Baltimore, MD ยท On-site
The Medical Nurse Reviewer applies clinical nursing expertise to review claims, medical records, and provider documentation for compliance with Medicare, Medicaid, and hospice-specific regulatory ...
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Baltimore, MD ยท On-site
The Medical Nurse Reviewer applies clinical nursing expertise to review claims, medical records, and provider documentation for compliance with Medicare, Medicaid, and hospice-specific regulatory ...
Burlingame, CA ยท On-site
The MSO Physician Reviewer is responsible for ensuring the appropriate utilization of healthcare services while maintaining high standards of patient care. This role involves conducting evidence ...
Burlingame, CA ยท On-site
The MSO Physician Reviewer is responsible for ensuring the appropriate utilization of healthcare services while maintaining high standards of patient care. This role involves conducting evidence ...
Middleton, WI ยท On-site
The Data Reviewer performs review of a variety of routine and complex analytical analysis experiments that are conducted on pharmaceutical and biopharmaceutical compounds with various formulations ...
Middleton, WI ยท On-site
The Data Reviewer performs review of a variety of routine and complex analytical analysis experiments that are conducted on pharmaceutical and biopharmaceutical compounds with various formulations ...
Albany, NY ยท On-site
Nurse Reviewer Work Hours: 8:30am-4:30pm/9am-5pm (Flexible) (37.5 hrs per week) hybrid position Unpaid Lunch Break Some Overtime No travel No Work required on a NYS Holiday Paid Parking Provided ...
Albany, NY ยท On-site
Nurse Reviewer Work Hours: 8:30am-4:30pm/9am-5pm (Flexible) (37.5 hrs per week) hybrid position Unpaid Lunch Break Some Overtime No travel No Work required on a NYS Holiday Paid Parking Provided ...
Myrtle Beach, SC ยท On-site
Summary Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals. Documents ...
Myrtle Beach, SC ยท On-site
Summary Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals. Documents ...
Jericho, NY ยท On-site
$38.46 - $43.27/hr
As a Clinical Reviewer (RN), you will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. You will utilize your knowledge and expertise of the review ...
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Jericho, NY ยท On-site
$38.46 - $43.27/hr
As a Clinical Reviewer (RN), you will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. You will utilize your knowledge and expertise of the review ...
Manhattan, NY ยท On-site
$122K - $187K/yr
The Medical Peer Reviewer will assess/review requests for authorization, and claims payment, based on medical records and internal Healthfirst information and make informed clinical judgments and ...
Manhattan, NY ยท On-site
$122K - $187K/yr
The Medical Peer Reviewer will assess/review requests for authorization, and claims payment, based on medical records and internal Healthfirst information and make informed clinical judgments and ...
Carolina, RI ยท On-site +1
Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated ...
Carolina, RI ยท On-site +1
Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated ...
Alabama, NY ยท On-site +1
Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated ...
Alabama, NY ยท On-site +1
Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated ...
Jericho, NY ยท On-site
$38.46 - $43.27/hr
Clinical Reviewer (RN) As a Clinical Reviewer, you will complete the full spectrum of activities related to Independent Dispute Resolution (IDR) case determinations. Conducting clinical level review ...
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Jericho, NY ยท On-site
$38.46 - $43.27/hr
Clinical Reviewer (RN) As a Clinical Reviewer, you will complete the full spectrum of activities related to Independent Dispute Resolution (IDR) case determinations. Conducting clinical level review ...
As a Merit Reviewer supporting our Federal government client, you will be trusted to serve as a Merit Reviewer for a program that aims to foster competition and innovation across the global ...
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As a Merit Reviewer supporting our Federal government client, you will be trusted to serve as a Merit Reviewer for a program that aims to foster competition and innovation across the global ...
The candidate would review and modify submission-ready clinical documents by demonstrating high attention to detail, in order to guarantee quality of the final document. The ability to work ...
The candidate would review and modify submission-ready clinical documents by demonstrating high attention to detail, in order to guarantee quality of the final document. The ability to work ...
Saint Louis, MO ยท On-site
$59K - $75K/yr
Nurse Reviewer The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing ...
Saint Louis, MO ยท On-site
$59K - $75K/yr
Nurse Reviewer The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing ...
Saint Petersburg, FL ยท On-site
Conduct review of facility and outpatient bills as it compares with medical records and coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest ...
Saint Petersburg, FL ยท On-site
Conduct review of facility and outpatient bills as it compares with medical records and coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest ...
$10.58 - $14.03
1% of jobs
$14.03 - $17.48
13% of jobs
$17.48 - $20.94
4% of jobs
$22.31 is the 25th percentile. Wages below this are outliers.
$20.94 - $24.39
18% of jobs
$24.39 - $27.84
14% of jobs
The median wage is $27.95 / hr.
$27.84 - $31.29
17% of jobs
$31.29 - $34.75
7% of jobs
$35.14 is the 75th percentile. Wages above this are outliers.
$34.75 - $38.20
12% of jobs
$38.20 - $41.65
8% of jobs
$41.65 - $45.10
5% of jobs
$45.10 - $48.56
1% of jobs
$10
$29
$48
| Aspect | Reviewer Reviewer | Content Reviewer |
|---|---|---|
| Required Credentials | Typically a high school diploma or equivalent; some roles may require a degree or certification in quality assurance or related fields | Usually a high school diploma; certifications in editing, content management, or quality assurance are common |
| Work Environment | Office or remote settings, reviewing documents, products, or services for quality and compliance | Office or remote, focusing on reviewing digital or written content for accuracy, clarity, and adherence to guidelines |
| Employer & Industry Usage | Used across industries like publishing, manufacturing, and customer service for quality control | Common in media, publishing, marketing, and online platforms for content accuracy and quality |
Reviewer Reviewer and Content Reviewer share similarities in their focus on quality and compliance, often requiring similar credentials and working in office or remote environments. However, Reviewer Reviewers typically oversee broader quality processes across products or services, while Content Reviewers focus specifically on digital or written content accuracy and adherence to guidelines.
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 13 days ago
Make clinical decisions for Behavioral Health and/or Medical requests using approved and accepted plan policies and criteria.
Determine eligibility and benefit coverage according to member and provider contracts.
Respond to requests for authorization of Behavioral Health and/or Medical services and inpatient procedures.