medical reviewer

Managed Medical Review Organization

<div><b>Position Title:</b> Physician Reviewer &ndash; Child &amp; Adolescent Psychiatrist<br>
<b>Organization:</b> Managed Medical Review Organization (MMRO)<br>
<b>Employment Type:</b> Independent Contractor<br>
<b>Industry:</b> Healthcare<p></p><b>
About MMRO</b><br>
Managed Medical Review Organization (MMRO) is an established, URAC-accredited Independent Review Organization (IRO) that provides objective, evidence-based medical peer reviews nationwide. We are currently seeking <b>Board-Certified </b><b>Child &amp; Adolescent Psychiatrist Physicians</b> to join our network of sub-contracted Physician Reviewers.<p></p><b>
Responsibilities</b><ul><li>
Conduct comprehensive and objective medical chart reviews with honesty and integrity.</li><li>
Produce determinations that are clear, concise, and well-supported by evidence.</li><li>
Follow MMRO&rsquo;s review templates, ensuring all required elements are complete and accurate.</li><li>
Communicate findings in a professional manner using appropriate language and grammar.</li><li>
Complete assigned reviews within the specified deadlines.</li><li>
Respond promptly to communications from MMRO staff.</li><li>
Review and comply with corporate training materials and review standards.</li><li>
Be receptive to constructive feedback from MMRO&rsquo;s Medical Director, Associate Medical Director, and Clinical Staff.</li><li>
Contribute ideas for process improvement and quality enhancement.</li></ul><p></p><b>
Qualifications</b><ul><li><b>
Licensure:</b> Current, non-restricted license to practice medicine in any U.S. state or territory.</li><li><b>
Board Certification:</b> Maintained certification by a board recognized by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA).</li><li><b>
Experience:</b><ul><li>
Minimum of <b>five (5) years</b> full-time equivalent experience (37.5&ndash;40 hours per week) providing direct clinical care to patients.</li><li><b>
Current clinical experience</b> within the past three (3) years.</li></ul></li><li><b>
Location:</b> Must be physically located within the United States or its territories while conducting reviews.</li></ul><p></p><b>
Why Partner with MMRO</b><ul><li>
Flexible, remote contract opportunity.</li><li>
Set your own schedule and case volume.</li><li>
Collaborate with an experienced and supportive clinical and operations team.</li><li>
Contribute to fair, evidence-based determinations that support quality healthcare decisions.</li></ul><p></p><b>
Join MMRO&rsquo;s network of expert physician reviewers and make an impact through clinical excellence and integrity.</b><br>
<p>
</p><p>Cssk47DS4M</p></div>

Psychiatrist- Child & Adolescent

Amgen

<div>
 Organization: Global Patient Safety
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 Team: PV Operations
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 Group Purpose: To provide medical review of individual safety case reports (ICSR) in support of safety surveillance for Amgen products. To support global individual case safety reports regulatory reporting compliance.
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 Job Summary:
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  <li>
   To assure medical validity of ICSRs and provide input to the activities of Medical Safety Review Team (MSRT)
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   Execute the medical review of ICSRs (narratives, coding, expectedness, causality and seriousness) to ensure quality reports.
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   To act as a point of contact for Case Management on medical content of ICSRs
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 </ul>
 Key Activites:
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 <ul>
  <li>
   Execute the medical review of ICSRs (narratives, coding, expectedness, causality and seriousness) to ensure quality reports. Produce medically accurate ICSRs reports
  </li>
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   Execute ICSR case escalation as appropriate
  </li>
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   Execute appropriate case follow up per SOPs
  </li>
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   Support medical coding conventions, and systematic process improvements for ICSR medical review
  </li>
  <li>
   Conduct reportability assessment for medical device associated events and /or product complaint associated events, and review for potential product problems.
  </li>
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   Support Quality Assurance of ICSR medical review (if applicable)
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   Provide input on teams for interdepartmental and cross-functional initiatives including, process improvement, standards development, Standard Operating Procedures (SOP) creation, and metrics with regards to medical review (if applicable)
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   Perform other duties related to the position as necessary as defined in SOPs or as requested by his/her supervisor
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  </li>
 </ul>
 Inspection Readiness:
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   Undertake activities delegated by the QPPV as detailed in the PV System Master File and maintain a state of inspection readiness
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   Be representative and point of contact for Health Authority Inspection and Internal Process Audits within the remit of role and responsibility
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 </ul>
 Knowledge and Skills :
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  <li>
   Knowledge of Amgen Medical review and Case Management SOPs and regulatory requirements for pharmacovigilance
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   Clinical knowledge of therapeutic area patient populations and drug class
  </li>
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   Proficiency in technical safety systems including Safety Database and medical coding
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  <li>
   Knowledge of safety data capture in Clinical Trials and Post Marketing setting
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   Knowledge of clinical trials and drug development
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   Knowledge of Amgen products and patient population (preferred)
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  </li>
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 Education &amp; Experience (Basic):
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 <ul>
  <li>
   MD/DO or international equivalent and 1 year of related drug safety experience
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 Education &amp; Experience (Preferred) :
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  <li>
   MD/DO or international equivalent plus 3 years of relevant work
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 </ul>
</div>


Medical Review Senior Associate Scientist

CLIRNet

<div><div><b>Job Title: Medical Writer
</b></div><div><b>Location: Saltlake Sec V, Kolkata
</b></div><div><b>Mode: Work from Office</b></div><div></div><div><b>
Key Responsibilities:</b></div><div>
1. Curation of Scien tific Articles in Q&amp;A format based on new Medical research</div><div>
2. Editing MedWikis based on conversations between Doctors on newer Medical Research across specialties</div><div>
3. Edit the conversation scientifically (consult NCBI/Google scholar journals or Guidelines for clarification) using passive voice</div><div>
4. The content of an answer needs to be tallied with a Reputed Scientific article; any discrepancy needs to be checked and corrected accordingly (consult NCBI/Google scholar journals or Guidelines for clarification).</div><div>
5. The dose of any drug, any combination of drugs, or the duration of any therapy should be according to the International/ National Guidelines.</div><div>
6. Only the generic names of the drugs/devices should be used.</div><div>
7. The content prepared should be plagiarism free (less than 5% plagiarism is accepted).</div><div>
8. Suggestion of medically relevant topics of discussion for doctors as per the latest trends.</div><div></div><div><b>
Essential Skillset:</b></div><div>
1. Ability to write/edit Scientific content based on new Medical research</div><div>
2. Plagiarism-free writing</div><div>
3. Error-free writing style</div><div>
4. Excellent primary research skills</div><div>
5. Team Player</div><div>
6. Very strong outlook towards science/healthcare/life-science</div><div></div><div>
Education Qualification &amp; Experience:</div><div>
1. PHD Any branch of Life-sciences</div><div>
2. Freshers may also apply.</div></div>

Medical Writer

OnDemand Healthcare

<p>We are looking for a supervisory physician with North Carolina licensure to review 10% of patients' charts once monthly for a telemedicine practice owned by a Family Nurse Practitioner. There will be a monthly incentive. We are based out of Texas but will be expanding our patient population to North Carolina.</p><p>Job Type: Contract</p><p>Pay: From $100.00 per month</p><p>Benefits:</p><ul><li>Flexible schedule</li></ul><p>License/Certification:</p><ul><li>BC/BE (Preferred)</li><li>Medical License (Required)</li></ul><p>Work Location: Remote</p>

Supervisory Physician (North Carolina)

Dane Street

<div><p>Dane Street wants you to join our dynamic team of expert reviewers! In this role, you will have the opportunity to utilize your medical expertise to conduct thorough reviews of clinical cases.</p><p>
This telework opportunity allows you to customize your schedule as a 1099 independent contractor.</p><p>
Your main task will be to evaluate medical records, provide clinical summaries, engage in peer communications, and answer specific questions posed by our clients.
</p><p>We are on the lookout for talented professionals in the following area:</p><p></p><ul><li>
Diagnostic Radiology
</li></ul><p></p><p>Be a part of a team that values your skills and dedication to improving patient care. Your expertise is vital to helping us deliver high-quality healthcare assessments.</p><p><b>
Requirements</b></p><p></p><ul>
<li>
Board Certified in Diagnostic Radiology</li>
<li>5+ years of clinical practice experience</li>
<li>Attends all required orientation and training</li>
<li>Maintains proper credentialing, state licenses, and any certifications or requirements necessary to perform the job</li>
</ul><p><b>
Benefits</b></p><ul>
<li>Independent consultant role allows for schedule flexibility and predictable work hours. You choose services and case types, dictate volume, and conduct this work based on your scheduled availability.</li>
<li>No doctor/patient relationship is established, and no treatment is provided. These are advisory-only opinions.</li>
<li>Dane Street offers a streamlined case flow and a user-friendly work portal. We facilitate all communication, organize and sort all medical records, support all administrative processes, prep cases extensively, and ensure the quality and timely delivery of all determinations/reports.</li>
<li>A chronological listing of medical records as well as all treatment guidelines used to make a determination are provided in an easy, click-to-view format.</li>
<li>Dane Street offers initial training as well as an ongoing point of contact should you have any questions about completing reviews.</li></ul></div>

Board Certified Physician Reviewers - Diagnostic Radiology - Remote

Med Media Partners, LLC

<p><b>Part-time Nurse Case Reviewer </b></p><p>It&rsquo;s the details that matter! ShimSpine is looking for an experienced professional to join our company as a Part-time Nurse Case Reviewer. As part of our team, you will be using a patented, industry-leading software application to analyze and develop case summaries for a myriad of clients. Our ideal candidate has a solid foundation in nursing and specialty experience with a firm grasp of medical terminology, treatments, and standards of care.</p><p><b>About Us</b></p><p>We are a medical and technology practice with a dynamic team that utilizes a patented, proprietary, industry-leading software application to help our clients, customers and patients achieve the best possible outcomes.</p><p><b>Duties and Responsibilities</b></p><p>&middot; Primary responsibility to review medical and legal documentation/records associated with the development of a medical chronology to provide written case summaries and analysis.</p><p>&middot; Review, extract and analyze complex medical data.</p><p>&middot; Evaluate the appropriateness of treatments provided.</p><p>&middot; Assist with refining and improving processes associated with reviewing cases.</p><p>&middot; Audit work of other team members.</p><p>&middot; Collaborate with other team members, physicians, and clients to develop a high-quality work product.</p><p>Requirements and Qualifications</p><p>&middot; Minimum of 5 years experience in nursing with an active Florida nursing license.</p><p>&middot; Able to consistently meet deadlines and produce high quality work is a must.</p><p>&middot; Proficiency with using a computer, Microsoft Word, and Google. Able to successfully navigate various software programs and have excellent typing skills.</p><p>&middot; Strong knowledge of medical terminology, medications and good understanding of common procedures/surgeries</p><p>&middot; Attention to detail and accuracy of work is a must.</p><p>&middot; Must be a team player with strong communication skills and commitment for quality improvement.</p><p>&middot; Self-motivated with excellent time management skills.</p><p>&middot; Willingness to continually learn new medical knowledge, new concepts and be a strong leader.</p><p>&middot; Must be able to stand/sit for long durations on a daily basis.</p><p>&middot; Prior experience (direct patient care) working in the ER, Orthopaedics, Neurosurgery, Neurology and/or surgery is a MUST.</p><p>&middot; Prior experience with utilization review, developing medical chronologies and/or legal experience is a plus.</p><p><b>This is an onsite position. No remote work.</b></p><p><b>Only those who have the above qualifications and experience are encouraged to apply.</b></p><p><b>ShimSpine is an Equal Opportunity Employer. Qualified candidates will be contacted for a preliminary phone screening. Background checks and reference verifications will be conducted prior to final offer.</b></p><p>Job Type: Part-time</p><p>Pay: $22.00 - $38.00 per hour</p><p>Application Question(s):</p><ul><li>Do you hold an active, unrestricted license as a nurse in Florida?</li><li>Starting salary expectations?</li><li>How many years clinical experience in Orthopaedics, Neurosurgery, or Neurology do you have (Relevant experience includes ER, specialty physician practice, med-surg, advance practice nurse and/or utilization review?</li></ul><p>Experience:</p><ul><li>Active LPN/RN Licensure in Florida: 5 years (Required)</li></ul><p>Ability to Commute:</p><ul><li>Oldsmar, FL 34677 (Required)</li></ul><p>Work Location: In person</p>

Part-time Nurse Case Reviewer / Case Analyst - Onsite | Florida Licensed | Ortho/Neuro

Molina Healthcare

<div>
 <strong>
  Job Description
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 <strong>
  Job Summary
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 Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care.
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  Job Duties
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   Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing.
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   Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions.
  </li>
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   Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers.
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   Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues.
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   Identifies and reports quality of care issues.
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   Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience.
  </li>
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   Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings.
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   Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions.
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   Supplies criteria supporting all recommendations for denial or modification of payment decisions.
  </li>
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   Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals.
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   Provides training and support to clinical peers.
  </li>
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   Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols.
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 <strong>
  Job Qualifications
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 <strong>
  REQUIRED QUALIFICATIONS:
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 <ul>
  <li>
   At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience.
  </li>
  <li>
   Registered Nurse (RN). License must be active and unrestricted in state of practice.
  </li>
  <li>
   Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC).
  </li>
  <li>
   Experience working within applicable state, federal, and third-party regulations.
  </li>
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   Analytic, problem-solving, and decision-making skills.
  </li>
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   Organizational and time-management skills.
  </li>
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   Attention to detail.
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   Critical-thinking and active listening skills.
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   Common look proficiency.
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   Effective verbal and written communication skills.
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   Microsoft Office suite and applicable software program(s) proficiency.
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 <strong>
  Preferred Qualifications
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 <ul>
  <li>
   Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications.
  </li>
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   Nursing experience in critical care, emergency medicine, medical/surgical or pediatrics.
  </li>
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   Billing and coding experience.
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   <br/>
  </li>
 </ul>
 To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
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 <br/>
 Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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 Pay Range: $29.05 - $67.97 / HOURLY
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  <li>
   Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
  </li>
 </ul>
</div>


Medical Review Nurse (RN)

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