Job Description Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated
The Clinical QA Supervisor is responsible for the oversight of the review of Physician reports and accompanying medical records to ensure that the report is complete, accurate, and consistent with medical evidence. Oversight of QA staff Ensure
Clinical Review Specialist | Admissions | Remote | $25/hourly Flexible Schedule · Part-Time with Path to Full-Time · Evenings & Weekends as Needed Banyan Treatment Centers is seeking a licensed clinician to serve as a Clinical Review Specialist
Delegation Oversight Manager Leads and directs team responsible for multi-state delegation oversight activities including monitoring of delegation oversight to ensure compliance with state, federal, National Committee for Quality Assurance (NCQA), and Molina requirements. Collaborates closely with
Job Title Provides support for member clinical service review processes specific to behavioral health. Job Description Provides support for member clinical service review processes specific to behavioral health. Responsible for verifying that services are medically necessary and align
Come for the Challenge. Stay for the Experience. At HCVT, we believe every challenge presents an opportunity to positively impact our clients and people. Talented and ambitious individuals who seek limitless professional opportunities thrive at HCVT.
Work ScheduleStandard (Mon-Fri) Environmental ConditionsOffice Job Description Join Us as a Clinical Research Associate (Level II) – Make an Impact at the Forefront of Innovation We have successfully supported the top 50 pharmaceutical companies and more
Work ScheduleStandard (Mon-Fri) Environmental ConditionsOffice Job Description Join Us as a Clinical Research Associate (Level II) – Make an Impact at the Forefront of Innovation We have successfully supported the top 50 pharmaceutical companies and more
About Pair Team At Pair Team, were an innovative, mission-driven company reimagining how Medicaid and Medicare serves the most underserved populations. As a tech-enabled medical group, we deliver whole-person care - clinical, behavioral, and social -
A Rare Opportunity to Shape the Future of Genomics Join a team of brilliant, passionate innovators determined to transform healthcare. At BillionToOne, weve built a category-defining, publicly traded company on Nasdaq where transparency fuels trust, collaboration
Labcorp is a leader in diagnostics, drug development and healthcare innovation. Across every role, we harness data and AI to work smarter, move faster and create breakthrough solutions that improve health outcomes for people. With our
Remote Prior Authorization Pharmacist Work From Home in Managed Care A confidential managed care organization is seeking a motivated Remote Prior Authorization Pharmacist to evaluate prescription requests, ensure medical necessity, and improve patient access to safe
Job Title Manages team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance. Collaborates with health plans identify and track savings
Job Title Molina Healthcare is hiring for remote Certified Pharmacy Technicians. Job Description These roles will be in our Prior Authorization department. You will review prior auth requests that are submitted. Shift times for these roles will
Job Title Investigative Support for Special Investigation Unit (SIU) Activities Provides investigative support for special investigation unit (SIU) activities. Responsible for supporting for the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to