Position Title:Medical Management Specialist I/ PHRN Shift: Job Description: Responsible for providing non-clinical support to the Medical Management and/or Operations areas. Primary duties may include, but are not limited to: Gathers clinical information regarding case and
Cruise Administration Services Inc. (CASI), a Carnival Cruise Line entity in the Philippines currently has a Specialist, Case Management role available. Only candidates located in the Philippines to apply. Job Summary: This role reports to the
Job Title: Clinical Documentation Specialist Position Type: Full-Time Work Hours: 9:00 AM to 5:00 PM Eastern Daylight Time Work Days: Monday to Friday Salary: $5 - $6 per hour, depending on experience Workplace: Remote Preferred Candidate
Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. Roles
NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are currently seeking a
Job Summary The Registered Nurse Team Lead will oversee a team of Philippine nurses supporting clinical review, utilization management, and healthcare operations. This role is responsible for ensuring quality standards, productivity, and compliance with healthcare regulations while
The Clinical Consultant provides clinical and operational support as a U.S. Healthcare Subject Matter Expert, providing various clinical support services and operational guidance for business processes, to include Case Management, Utilization Management, Clinical Coverage Preservice, Claims and
Profile Summary: Favorably impact Stop Loss risk profile through early identification of potential high-cost patients. Profile Description: Serves as a subject matter expert in the evaluation of medical information to clarify diagnoses, evaluate the severity of
Profile Summary: Favorably impact Stop Loss risk profile through early identification of potential high cost patients. Profile Description: • Serves as a subject matter expert in the evaluation of medical information to clarify diagnoses, evaluate the