Top 4527 Medical reviewer Jobs

Referral Management (Non-Nurse) Reviewer
Zimmerman Associates, Inc. —Bethesda, MD
- $23.56 an hour
- Microsoft Excel
- Microsoft Outlook
- Mid-level
RN / Medical Reviewer / Remote
InGenesis —Columbia, SC
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
LPN/Medical Reviewer - Remote
Computer Enterprises Inc —Columbia, SC
- $23 an hour
- Contract
- Research
- Mid-level
- LPN
Quick Apply
Care Plan Reviewer- OhioRISE
CVS Health —Ohio
- $60,522 - $129,615 a year
- Full-time
- LMFT
- Mid-level
- Outpatient experience
- Health insurance
- Dental insurance
11d
Referral Management (Non-Nurse) Reviewer
Zimmerman Associates, Inc. —Bethesda, MD
- $24.13 an hour
- Microsoft Excel
- Microsoft Outlook
- Mid-level
Review Content for Medical Accuracy (Medical Fact Checker / Reviewer)
OnrampLab —New York, NY
- $50 - $70 an hour
- Remote
- Mid-level
- Ob/Gyn
- Communication skills
Quick Apply
12d
Medical Content Reviewer - Remote - Nationwide
Vituity —Sacramento, CA
- $60 an hour
- Per diem
- Remote
- Google Workspace
- English
- Mid-level
Freelance Medical Reviewer, MyHealthTeam
MyHealthTeam —Remote
- $20 - $75 an hour
- Remote
- Medicine
- Mid-level
- Psychology
Complex Medical Bill Reviewer
Enlyte —Remote
- $53,500 - $70,000 a year
- Full-time
- Remote
- Surgery
- LVN
- RN License
- Health savings account
- AD&D insurance
MEDICAL REVIEWER
Zenith LifeScience —South Plainfield, NJ
- $100,000 - $120,000 a year
- Full-time
- Medicine
- Microsoft Excel
- English
Expert Reviewer
Grant Engine —Remote
- Part-time
- Medicine
- English
- Doctor of Philosophy
Utilization Reviewer (Applied Behavior Analysis)
Hawaii Medical Service Association —Honolulu, HI
- Applied behavior analysis
- Mid-level
Medical Peer Reviewer
Healthfirst —Remote
- $122,907 - $188,020 a year
- 8 hour shift
- Medicine
- Mid-level
- Communication skills
- Paid holidays
- Health insurance
Medical Content Reviewer
Ro —New York, NY
- Contract
- Remote
- Medicine
- Research
- Mid-level
Quick Apply
Dispute Resolution Reviewer I
TMF Health Quality Institute —Remote
- Full-time
- Remote
- Research
- Mid-level
- Associate's degree
- AD&D insurance
- Disability insurance
Physician Reviewer
MedReview —Remote
- $230,000 a year
- Full-time
- Remote
- Medicine
- 5 years
- BC/BE
Quick Apply
Dispute Resolution Reviewer III (Healthcare Professional)
TMF Health Quality Institute —Remote
- Full-time
- Remote
- Writing skills
- Research
- Mid-level
- AD&D insurance
- Disability insurance
Reviewer, PRN
Chen Medical Associates —Miami, FL
- Full-time
- Remote
- Entry level
- Opportunities for advancement
NSQIP Surgical Clinical Reviewer: Part-Time
Q-Centrix —Remote
- $32 - $37 an hour
- Part-time
- Remote
- Surgery
- Mid-level
- Microsoft Office
- Health insurance
- Flexible schedule
Quick Apply
Initial Clinical Reviewer
Enlyte —Remote
- $59,000 - $73,000 a year
- Full-time
- Remote
- Clinic experience
- Mid-level
- Analysis skills
- Health savings account
- AD&D insurance
5d

I want to receive the latest job alert for medical reviewer

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

medical reviewer jobs near

Referral Management (Non-Nurse) Reviewer

Zimmerman Associates, Inc. -
Bethesda, MD

Apply Now

Job Details

$23.56 an hour

Qualifications

Customer communication
Microsoft Excel
Microsoft Outlook
Associate's degree
Medical terminology

Full Job Description

Zimmerman Associates, Inc. (ZAI) is seeking to hire multiple Referral Management (Non-Nurse) Reviewers to support our contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Region’s premier authority for appointment coordination and referral management services for beneficiaries within the Defense Health Network.

Pay Rate: $23.56 per hour plus $4.93 Health & Wellness Fringe

Role and Responsibilities:

Referral Management (Non-Nurse) Reviewers will facilitate centralized product line and specialty referrals for Active-Duty Service Members and TRICARE Prime beneficiaries enrolled at Military Treatment Facilities (MTFs) within the National Capital Region.

This is an onsite opportunity

Qualifications / Skills / Experience:

Minimum of an Associate’s degree
At least 2 years of experience in Utilization Management, Referral Management, Authorization/Denials, or Medical Claims Processing/Insurance Referral
U.S. Citizenship required, with the ability to obtain a Public Trust Clearance
Knowledge of medical care criteria such as InterQual, Milliman Ambulatory Care Guidelines, Specialty Referral Guidelines (SRGs), or other evidence-based Military Health System (MHS) guidelines
Familiarity with medical terminology and ability to learn MHS, VA-DOD Sharing Program, TRICARE, HIPAA, and release of medical information protocols
Excellent communication and interpersonal skills
Strong customer service orientation
Understanding of Access to Care Standards within the Direct Care System
Attention to detail, including correct use of deferral codes
Strong organizational skills with ability to prioritize tasks and manage time effectively
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Access, Outlook) and internet navigation

Essential Tasks:

Review and process referrals for administrative and clinical completeness and appropriateness, completing disposition within 24 hours of referral date
Collaborate with appointing centers, case managers, product line nurses, providers, clinics, managed care contractors, and other healthcare team members to ensure appropriate use of Direct Care and civilian network resources
Ensure patients are scheduled with the right provider, at the right time and place
Review compliance with Specialty Referral Guidelines (SRGs) per IRMAC protocols
Complete and return Clear Legible Reports (CLR) to ordering civilian providers within required Return of Favorable Response (ROFR) timelines
Manage telephone, written, and electronic communications regarding specialty appointments and referrals
Monitor and process referral management worklists (e.g., Genesis Work Lists) to ensure timely consult processing
Communicate referral status to patients, including benefit counseling and advocacy resources as needed
Reschedule or redirect patients within 3 days when referrals are disapproved or invalid, advising on other care options and Line-of-Duty issues
Receive and enter ROFR referrals in MHS-GENESIS from Military Contractor Support Centers (MCSC) portals for assigned specialties/product lines, adhering to all timelines and business rules
Verify patient eligibility and update demographics in MHS-GENESIS
Document patient interactions, especially when appointments are refused, and coordinate with Beneficiary Counselor and Assistance Coordinator as appropriate
Coordinate with product line nurses and clinics for special accommodations
Interface with MCSC and multidisciplinary teams to ensure referral appropriateness
Submit referrals to non-network providers for TRICARE Service Center medical necessity reviews
Monitor referral management voicemail and return patient calls within established guidelines
Provide External Provider Referral Online (EPRO) information as requested
Close unused referrals following DHA IPM and NCR Medical Directorate policies, notifying ordering providers accordingly
Orient and train new IRMAC staff on referral processes and timelines
Perform other duties as assigned

Zimmerman Associates, Inc. is an equal opportunity employer. We comply with Federal and State Equal Opportunity laws and consider qualified applicants without regard to race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, veteran status, or any other protected status.

#INDSPN

Apply Now

Refine Your Search

medical reviewer jobs

Referral Management (Non-Nurse) Reviewer

RN / Medical Reviewer / Remote

LPN/Medical Reviewer - Remote

Care Plan Reviewer- OhioRISE

Referral Management (Non-Nurse) Reviewer

Review Content for Medical Accuracy (Medical Fact Checker / Reviewer)

Medical Content Reviewer - Remote - Nationwide

Freelance Medical Reviewer, MyHealthTeam

Complex Medical Bill Reviewer

MEDICAL REVIEWER

Expert Reviewer

Utilization Reviewer (Applied Behavior Analysis)

Medical Peer Reviewer

Medical Content Reviewer

Dispute Resolution Reviewer I

Physician Reviewer

Dispute Resolution Reviewer III (Healthcare Professional)

Reviewer, PRN

NSQIP Surgical Clinical Reviewer: Part-Time

Initial Clinical Reviewer

I want to receive the latest job alert for medical reviewer

Related Searches

Explore jobs in more locations

Role and Responsibilities:

Qualifications / Skills / Experience:

Essential Tasks:

Job Seeker Tools

Employer Tools

Browse

Stay Connected