14 medical reviewer jobs found

Become a part of our caring community The Utilization Management Behavioral Health Professional uses behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Behavioral Health Professional uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas....

Senior Offensive Security & Exposure Management Analyst Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Senior Security Analyst will operate and evolve continuous penetration testing capabilities to uncover exploitable attack paths, simulate adversary behavior, and drive measurable risk reduction. You'll partner closely with engineering, cloud, and security...

Cybersecurity Senior Advisor - Offensive Security & Exposure Management Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Cybersecurity Senior Advisor will own and advance our offensive security and exposure management program. This role is responsible for driving strategy, scaling automated penetration testing, and delivering measurable risk reduction across...

Responsibilities: Wellstone Regional Hospital is a 100-bed acute care facility located in Jeffersonville, Indiana and has been providing quality health care to the residents of Southern Indiana and the Louisville area since 2003. Wellstone specializes in the treatment of Adolescents, Children, Adults, and the CD population. In addition to our in-patient services, we offer out-patient programs as well. Wellstone currently has an opening for a full-time UM Coordinator in the UM Department. The Utilization Review Coordinator is responsible for executing the UR function, which includes the implementation of case management scenarios, consulting with all services to ensure the provision of an effective treatment plan for all patients. Oversees the response to requests for services and interfaces with managed care organizations, external reviewers, and other payers. Assures that good customer service practices are utilized. Maintains denials and appeals logs and reviews the...

Every day, Global Payments makes it possible for millions of people to move money between buyers and sellers using our payments solutions for credit, debit, prepaid and merchant services. Our worldwide team helps over 3 million companies, more than 1,300 financial institutions and over 600 million cardholders grow with confidence and achieve amazing results. We are driven by our passion for success and we are proud to deliver best-in-class payment technology and software solutions. Join our dynamic team and make your mark on the payments technology landscape of tomorrow. As our Head of Inventory Management you will ensure accurate, timely, and efficient management of hardware and asset inventory of hWP and hGP organizations including oversight of other regions including UK & I, Poland, Germany, MX, Chile, Asia, Spain and Central and Eastern Europe. Enable seamless client deployment through proactive inventory planning and controls. RESPONSIBILITIES Demand...

Position Description & Qualifications The Army PPB BOS program is seeking a CM Specialist to deliver cloud-based configuration management, DevSecOps, and release engineering activities to support the enterprise systems. Serco supports the US Army as the prime for PPB BBOS and consists of multiple managed cloud environments and numerous hosted data, applications, and processes that enable Army Planning, Programming and Budgeting (PPB) processes to develop the Army Future Years Defense Program (FYDP). Our team performs administration, maintenance, and improvement of IT systems that collect POM, Budget Estimate Submission (BES) and President's Budget resources data deemed necessary to accomplish the Department's mission. In this role, you will: Support applications and systems operating within AWS GovCloud and Commercial Cloud environments/ Be responsible for developing, maintaining, and enforcing software configuration management tools and processes that...

Job Description Staff Program Manager, Incident Management - Autonomous Vehicle Development At General Motors, our product teams are redefining mobility. Through a human-centered design process, we create vehicles and experiences that are designed not just to be seen, but to be felt. We're turning today's impossible into tomorrow's standard - from breakthrough hardware and battery systems to intuitive design, intelligent software, and next-generation safety and entertainment features. Every day, our products move millions of people as we aim to make driving safer, smarter, and more connected, shaping the future of transportation on a global scale. The Safety Assurance for Effective Autonomous Driving Software (SAFE-ADS) department is part of GM's Global Product Safety, System, and Certification (GPSSC) organization. Our mission is to help GM deliver trusted automated driving products. As the central authority for automated driving system (ADS) safety, SAFE-ADS brings...

Position Overview At PNC, our people are our greatest differentiator and competitive advantage in the markets we serve. We are all united in delivering the best experience for our customers. We work together each day to foster an inclusive workplace culture where all of our employees feel respected, valued and have an opportunity to contribute to the company's success. As an Account Manager I within PNC's Treasury Management Sales organization, you will be based in Pittsburgh PA or Philadelphia PA or East Brunswick NJ or Little Falls NJ or Washington DC or Baltimore MD or Charlotte NC or Atlanta GA or Tampa FL or Jacksonville FL or Coral Gables FL or Birmingham AL or Dallas TX or Houston TX or Austin TX or Chicago IL or Cleveland OH or Columbus OH or Troy MI or Denver CO or Phoenix AZ or Tucson AZ or Irvine CA or Walnut Creek CA or San Jose CA or Settle WA or Portland OR or Indianapolis IN. This position is designed to act as an extension of our Treasury Management sales...

Position Overview At PNC, our people are our greatest differentiator and competitive advantage in the markets we serve. We are all united in delivering the best experience for our customers. We work together each day to foster an inclusive workplace culture where all of our employees feel respected, valued and have an opportunity to contribute to the company’s success. As a(n) [position title] within PNC's [name of division] organization, you will be based in [city/state location of position]. Job Profile Position Overview At PNC, our people are our greatest differentiator and competitive advantage in the markets we serve. We are all united in delivering the best experience for our customers. We work together each day to foster an inclusive workplace culture where all of our employees feel respected, valued and have an opportunity to contribute to the company’s success. As an Account Manager I within PNC's Treasury Management Sales organization, you will be based...

Senior Backend Architect - Device Management Platforms Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. PLEASE NOTE: This position is not eligible for current or future visa sponsorship. Carebridge Health is a proud member of the Elevance Health family of companies within our Carelon business. Carebridge Health exists to enable individuals in home and community-based settings to maximize...

Appointment Status: Tenure Track Department: IU Northwest School of Business & Economics Location Northwest Position Summary The Assistant Professor of Management Information Systems is a tenure-track, full-time, 10-month academic position. The position is responsible for a 12-hour per semester teaching load in Management Information Systems and related areas at both the undergraduate and graduate levels. A productive program of research and scholarly publication is expected which may be supported by a reduction in teaching load. Active involvement in service functions is also expected. The IU Northwest School of Business & Economics employs 15 full-time faculty, and its programs are fully accredited by the AACSB (Association to Advance Collegiate Schools of Business International). The successful hire will be required to maintain one or more faculty qualification status in accordance with AACSB guidelines. Faculty...

JOIN THE TEAM THAT'S POWERING PROGRESS Building cities. Driving commerce. Fueling Progress. For over 100 years, Allison has powered the vehicles and technology that move our world forward.What powers us? Our employees. From the first person hired by James Allison in 1915 to the thousands across the globe who work for Allison today, we're driving progress everywhere because we employ top talent worldwide. In both the Allison Transmission and Allison Off-Highway Drive and Motion Systems business units, our team strives to Improve the Way the World Works. Learn more about this role and how you can begin driving your career forward! Benefits: The below list features some of the benefits currently available. Eligibility may be subject to the terms and conditions of governing documents and available benefits may be subject to change at the company's discretion. Choice of medical plans with prescription coverage Employer HSA contribution Dental & Vision...

JOIN THE TEAM THAT’S POWERING PROGRESS Building cities. Driving commerce. Fueling Progress. For over 100 years, Allison has powered the vehicles and technology that move our world forward. What powers us? Our employees. From the first person hired by James Allison in 1915 to the thousands across the globe who work for Allison today, we're driving progress everywhere because we employ top talent worldwide. In both the Allison Transmission and Allison Off-Highway Drive and Motion Systems business units, our team strives to Improve the Way the World Works. Learn more about this role and how you can begin driving your career forward! Benefits: The below list features some of the benefits currently available. Eligibility may be subject to the terms and conditions of governing documents and available benefits may be subject to change at the company’s discretion. Choice of medical plans with prescription coverage Employer HSA contribution Dental &...

Job Summary In collaboration with the Senior Director of Clinical Management, the Director is responsible for the operational strategy and management of Otsuka clinical programs, including coordination with other relevant parties (e.g., other Otsuka departments, external service providers (ESPs), etc.). Responsibilities include the planning, execution, and completion of clinical programs according to applicable regulations and guidance; ICH Guidelines, Good Clinical Practices (GCP), and Otsuka SOPs, within agreed upon timelines and budget. Job Description Provides scientific clinical research and operational expertise in the development of overall strategy and objectives of the Global Clinical Development Plan (GCDP), including performing/overseeing and providing background research. May represent Clinical Management in the development of the Clinical Development Plan, timelines, and budget for Business Development opportunities. Ensures program specific...