22 Clinical Review Jobs

As a Nurse Advisor in the US Healthcare industry, your primary role will be to provide a comprehensive clinical review of complaints and appeals filed by providers. This involves utilizing appropriate resources and guidelines to ensure the cost-effective delivery of health services. You will be responsible for supporting the identification and review of suitable case types in compliance with clinical guidelines. Your contribution will be vital in promoting and supporting the quality effectiveness of healthcare services. Accuracy in applying review requirements to ensure that cases are reviewed by practitioners with clinical expertise for the specific issues at hand is crucial. Furthermore, y...

As a reviewer at a US based MNC in Vadodara, Gujarat, India, your primary responsibility will involve reviewing and verifying large volumes of patient's full medical records with precision. You will be required to perform clinical reviews according to specific methodologies and prepare detailed reports including chronologies, timelines, summaries, mass tort matrix, and medical opinions on case validity and valuation. Your key responsibilities will include: - Analyzing and summarizing medical records for pre and post-settlement projects. - Interpreting clinical data using medical terminology and diagnosis. - Adhering to company policies and principles to maintain the Company culture. - Ensuri...

Skill required: Claims Appeals - Claims Administration Designation: Health Admin Services Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 years About Accenture Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the world's largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We e...

Review clinical notes, radiographs, intraoral photos, & perio charts for medical necessity & consistency Evaluate frequency/age/interval limitations and payer-specific policies Perform pre-submission QA checks & post-denial clinical audits Required Candidate profile Strong knowledge of documentation requirements. Experience reviewing radiographs and clinical images for necessity and prognosis.

We will consider only 3+ Year experience candidates. (Clinical/Non-Clinical experienced both can be considered) REPORTING RELATIONSHIP POSITION REPORTS TO : MEDICAL TEAM LEAD DEPARTMENT : OPERATIONS POSITION LOCATION : VADODARA, GUJARAT, INDIA (On-Site) COMPANY BUDGET : 8,00,000 to up to 12,00,000 PA. POSITION SUMMARY The role will be to review and verify large volumes of patient's full medical records with precision, perform clinical reviews as defined by the specific review methodologies and prepare a detailed report that includes chronologies and timelines, summaries, mass tort matrix and medical opinions on case validity and valuation. JOB RESPONSIBILITIES o Analyzing and summarizing med...

Position Reports To : Medical Team Lead Department : Operations Position Summary : - The role will be to review and verify large volumes of patient's full medical records with precision, perform clinical reviews as defined by the specific review methodologies and prepare a detailed report that includes chronologies and timelines, summaries, mass tort matrix and medical opinions on case validity and valuation. Job Responsibilities : - Analyzing and summarizing medical records for pre and post settlement projects. Interpreting clinical data in terms of medical terminology and diagnosis. o Adhering to company policies/ARCHER principles and hence taking good care of Archer culture. Adhere to Hea...

About the Company - Asian Hires Vadodara, Gujarat, India (On-site) Company budget: 6,20,000 PA. (For FRESHER'S) Experienced can get up to 8,00,000 PA. Non-Clinical Job in US based MNC About the Role - The role will be to review and verify large volumes of patient's full medical records with precision, perform clinical reviews as defined by the specific review methodologies and prepare a detailed report that includes chronologies and timelines, summaries, mass tort matrix and medical opinions on case validity and valuation. Responsibilities Analyzing and summarizing medical records for pre and post settlement projects. Interpreting clinical data in terms of medical terminology and diagnosis. ...

As a Medical Officer at Asian Hires in Vadodara, Gujarat, India, your role will involve reviewing and verifying large volumes of patient's full medical records with precision. You will be responsible for performing clinical reviews as per specific methodologies and preparing detailed reports including chronologies, timelines, summaries, mass tort matrix, and medical opinions on case validity and valuation. Your key responsibilities will include: - Analyzing and summarizing medical records for pre and post-settlement projects. - Interpreting clinical data using medical terminology and diagnosis. - Adhering to company policies and principles to maintain the Company culture. - Ensuring complian...

You will be part of a non-clinical role in a US based MNC where you will review and verify large volumes of patient's full medical records with precision, perform clinical reviews, and prepare detailed reports. Responsibilities: - Analyzing and summarizing medical records for pre and post settlement projects. - Interpreting clinical data using medical terminology and diagnosis. - Adhering to company policies & principles to maintain the Company culture. - Ensuring compliance with the Health Insurance Portability and Accountability Act (HIPPA) at all times. - Providing daily reports to the Medical team lead regarding productivity & quality. Qualifications: - MBBS degree (No experience require...

Were Hiring Prior Authorization QA | Hyderabad (Gachibowli) Eligibility 4+ Years in Prior Auth 1+ Year as QA (On/Off papers, but must be QA exp) Must have Clinical Review Process experience with Life Science background Qualification: Inter & Above Salary: Up to 47K Take-Home 2-Way Cab (30 KM radius) Night Shift (6:30 PM – 3:30 AM) Hyderabad – Gachibowli Immediate Joiners (Relieving letter not mandatory) Apply Now: Dharani – 9100982938 (WhatsApp your resume) dharani.palle@axisservice.co.in Referrals are Welcome – Share with friends & colleagues!

Job Description for Senior Clinical Tool Specialist You will assist and lead in the research, creation and development of Clinical Tools and Classification Systems such as groupers, classifiers, stagers, and patient segmentation. Work in a collaborative manner with support from data analyst to data scientist to ensure our clinical tools are world class and fit for the purposes of clinical risk management (ranging from cost containment to quality and clinical pathways). Core Responsibilities Include How you would make a difference Evaluate and recommend improvements to the current clinical tools include but not limited to diagnosis related groupers, disease episode groupers, patient risk scor...

Key Responsibilities: Manage general medicine OPD and inpatient cases Conduct daily patient rounds and assist in treatment planning Ha ndle medical emergencies and coordinate with ICU teams Maintain accurate patient records and documentation Participate in academic and clinical discussions. Consultation with the patients and about his medical history. Examining the patient medical record histories. Fresher candidates preffered.

Nurse Level 1/2A Job Group Healthcare Family Name Complaints, Grievance and Appeals Job Title Nurse Level 1/2A Functional Title Coding Reconsideration - Nurse Consultant Exemption Status Non-Exempt Family Summary/Mission Provide comprehensive clinical review of complaints and appeals filed by providers with the use of appropriate resources and guidelines to ensure cost effective delivery of health service Position Summary/Mission Supports identification and review of appropriate case types in compliance with the clinical guidelines Promotes/supports quality effectiveness of Healthcare Services. Fundamental Components & Physical Requirements (include but are not limited to) Reviews documentat...

EVBV Roles also open Apply now Mumbai and Hyderabad! Location : Mumbai Roles: Prior Authorization& EVBV Salary: Up to 5.75 LPA Experience: Minimum 1 year in Prior Auth Degree: Mandatory Relieving Letter: Mandatory Notice Period: 0- 60 Days Interested candidates can share your updated resume to HR Sumalika - 9030461574 (share resume via WhatsApp) Refer your friend's / Colleagues Prior authorization- Quality Assurance role for Hyderabad Eligibility: Min 4yrs into Prior Auth and 1 year as a Prior Auth QA On Or Off Papers is fine but must have QA exp only Note :- Candidate must have work experience in clinical review process. Package :- Upto 47K Take-home Location :- Hyderabad. Qualification :- ...

Job Description for Senior Clinical Tool Specialist You will assist and lead in the research, creation and development of Clinical Tools and Classification Systems such as groupers, classifiers, stagers, and patient segmentation. Work in a collaborative manner with support from data analyst to data scientist to ensure our clinical tools are world class and fit for the purposes of clinical risk management (ranging from cost containment to quality and clinical pathways). Core Responsibilities Include How you would make a difference Evaluate and recommend improvements to the current clinical tools include but not limited to diagnosis related groupers, disease episode groupers, patient risk scor...

As a Medical Superintendent, you are responsible for overseeing patient clinical care, maintaining quality assurance, developing policies, ensuring compliance, and fostering a culture of continuous improvement in clinical outcomes. Your role involves a combination of clinical oversight and delivering exceptional healthcare services while driving clinical excellence. You will lead and foster a collaborative, excellence-driven multidisciplinary clinical team. Working closely with specified resources in the management team, you will ensure the identification, clinical review, and recommendations for hiring new doctors. Additionally, you will oversee medical practitioners to ensure adherence to ...

The company Asian Hires based in Vadodara, Gujarat, India is offering a non-clinical job opportunity in a US-based MNC. The annual budget for freshers is 6,20,000 PA, while experienced candidates can earn up to 8,50,000 PA. As a Medical Officer at Asian Hires, your primary role will involve reviewing and verifying large volumes of patient's complete medical records with precision. You will be responsible for performing clinical reviews as per specific methodologies, preparing detailed reports including chronologies, timelines, summaries, mass tort matrix, and providing medical opinions on case validity and valuation. Your responsibilities will include analyzing and summarizing medical record...

The primary responsibility of this role is to manage Regulatory Affairs in compliance with relevant regulations and guidelines for the organization. As a Regulatory Affairs Manager at DDReg, you will be involved in reviewing clinical, biopharmaceutical, non-clinical, and labelling documentation. Your duties will include preparing and reviewing non-CMC sections, Variations, site transfers, and conducting post-approval gap analysis. Additionally, you will support the regulatory function through document management, electronic submission compilation, and other group management activities as needed. Collaboration with various departments such as Regulatory Affairs, Quality Assurance, Quality Con...

The role of the Medical Officer based in Vadodara, India involves reviewing and verifying large volumes of patient's full medical records with precision. You will be responsible for performing clinical reviews as per specific methodologies and preparing detailed reports including chronologies, timelines, summaries, mass tort matrix, and medical opinions on case validity and valuation. Your key responsibilities will include analyzing and summarizing medical records for pre and post-settlement projects, interpreting clinical data using medical terminology and diagnosis, and adhering to company policies and ARCHER principles to maintain the Archer culture. It is essential to comply with the Hea...

As a Nurse Practitioner in the BPO (Healthcare) industry located at Infopark, Kakkanad, Kochi, you are required to have a minimum of 2 years of clinical experience. The role entails working the Night Shift from 6PM to 3AM with a monthly salary ranging from 30,000/- to 40,000/-. Fluency in English is a necessity for effective communication. Your responsibilities will include providing a comprehensive clinical review of complaints and appeals from providers, ensuring cost-effective delivery of health services by adhering to appropriate resources and guidelines. You will support the identification and review of suitable case types as per clinical guidelines, promoting quality effectiveness of H...

Roles and Responsibilities Entering of patient demogrpahics and insruance information. Verifying Insurance Policy coverage from the webportal. Order Corrections for the screnrios : Changes in the calories, different product, Hospital Re-admit, discharge, patient expired. Delivery Worksheet : Orders are being picked from the Patient Medical records Monthly facility billing (PART A Report ) and MA reports are prepared and sent to the client. Develop understanding of client specifics and requirements File are split and renamed as per the client naming convention. Renamed Invoices are allocated to the users for further tasks Based on the Invoice, users should reconcile or enter the PO in the acc...

Position Reports To : Medical Team Lead Department : Operations Position Summary : - The role will be to review and verify large volumes of patient's full medical records with precision, perform clinical reviews as defined by the specific review methodologies and prepare a detailed report that includes chronologies and timelines, summaries, mass tort matrix and medical opinions on case validity and valuation. Job Responsibilities : - Analyzing and summarizing medical records for pre and post settlement projects. Interpreting clinical data in terms of medical terminology and diagnosis. o Adhering to company policies/ARCHER principles and hence taking good care of Archer culture. Adhere to Hea...