Clinical Pharmacist Reviewer

Required skills: Physician with an active US licensed with experience in with medical coding (CPT/HCPCS) and managed care to conduct clinical review of claims and UM authorization requests for clinical necessity.Minimum of recent (last 2-3 years) 3-5 clinical experience in emergency dept medicine, experience in internal medicine will be considered. Experience in managed care, clinical UM case reviews. Knowledge of claims and medical coding (CPT/HCPCS codes). Proficient working in various system

Clinical Research Leader Summary: This Clinical Research Leader will be responsible for leading and supporting one or several clinical trials within the Clinical R&D Department while fostering strong, productive relationships with colleagues across the organization. Responsibilities: Serve as a Clinical Research Leader within the Clinical R&D Department to execute and manage company sponsored clinical trials, ensuring compliance with timelines and study milestones Oversight/execution of feasi

Job Title: Registered Nurse Clinical Auditor - (Junior)Location: Remote Job Description: We are seeking a detail-oriented Registered Nurse to support medical record reviews and billing compliance audits for State Medicaid Programs. This role is responsible for evaluating quality of care, reviewing medical records and program policies and identifying compliance issues, preparing audit documentation and reports, and supporting appeals activities. The ideal candidate brings clinical knowledge, reg

Immediate need for a talented Pharmacy Operations Senior Representative. This is a 05+ months contract opportunity with long-term potential and is location in IL, TX, TN, NM, OK or MT(Remote). Please review the job description below and contact me ASAP if you are interested. Job Diva ID : 26-17656 Pay Range: $20 - $21.99/hr. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Key Responsi