Clinical reviewer jobs in North Bergen, New Jersey - Page 3Crear alertas

Responsibilities include reviewing medical records and providing clinical summaries, while offering advisory services without establishing doctor-patient relationships.

Job Description A large public healthcare organization supporting a managed care health plan is seeking experienced HEDIS Quality Reviewers to support quality improvement and regulatory reporting initiatives. This role focuses on medical record review, provider collaboration, and quality auditing to ensure compliance with HEDIS and QARR standards. Responsibilities: * Maintain working knowledge of medical record review processes and EMR systems * Maintain up-to-date knowledge of HEDIS, QARR, and STAR specifications * Distribute medical record requests and schedule appointments with provider offices * Perform clinical audits via EMR, paper records, and on-site provider visits * Measure compliance with preventive health guidelines and quality standards * Identify, track, and report variations from standards of care * Design and support interventions to improve quality outcomes * Enter accurate and timely clinical quality findings into designated systems * Support quality improvement initiatives and interdepartmental process improvement projects * Provide education and guidance to physicians and staff to improve documentation and performance * Facilitate retrieval of electronic and paper medical records for HEDIS/QARR * Record patient encounter findings and relevant data in databases * Participate in annual HEDIS and QARR hybrid medical record review projects * Support and guide temporary staff during record reviews * Serve as a final reviewer for HEDIS and QARR records as needed * Perform other duties as assigned by Quality Management leadership Qualifications: * High School Diploma or GED required * Clinical background preferred (Health Educator, Medical Assistant, Nursing Assistant, LPN, RN, LMSW, LCSW, or Foreign Medical Graduate) * Minimum of two years HEDIS medical record review experience * Three to five years of quality improvement experience in healthcare or managed care strongly preferred * Experience with HEDIS and QARR in a managed care, health plan, or provider office setting * Ability to read, interpret, and audit medical records against quality standards * Experience using EMR systems such as EPIC or Quadramed * Knowledge of ICD-10 and CPT codes preferred * Proficiency in Microsoft Word, Excel, PowerPoint, and Access * Ability to travel within the service area as required Company DescriptionATRIA Consulting is a nationally certified women-owned small business (WBE, WSOB) that offers comprehensive Staffing and Recruiting services.ATRIA Consulting is a nationally certified women-owned small business (WBE, WSOB) that offers comprehensive Staffing and Recruiting services.

Job Description Dental Hygienist Reviewer / Contract - Downstate, NY (#25303) • Location: Downstate, New York, • Employment Type: Part-time, Contract, • Hourly Rate: $55/hr About Greenlife Healthcare Staffing: Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals. Position Overview: We are seeking an experienced Dental Hygienist Reviewer to conduct on-site monitoring and quality improvement reviews for a respected non-profit organization in Downstate, New York. This contract position combines clinical expertise with quality assurance skills to evaluate dental care services, with a focus on pediatric dental care standards. Why Join Us? • Competitive Compensation: Earn $55 per hour, • Work Schedule: Part-time, Contract position with flexible scheduling, • Professional Growth: Gain valuable experience in quality improvement and utilization review, • Impactful Work: Contribute to improving dental care standards and patient outcomes Key Responsibilities: • Completes all pre-review activities, including scheduling, notification, review of previous monitoring information, and other protocols as required., • Review patient records for all required components and time frames., • Executes site observation and notes any deficiencies., • Makes appropriate recommendations as a result of monitoring activities., • Provides technical assistance to personnel where appropriate., • Utilizes data management tools appropriately to record monitoring findings., • Prepares provider monitoring reports in accordance with monitoring findings., • When assigned, participates in case debriefs and/or accepts additional assignments as per the request of supervisors Greenlife Healthcare Staffing - Empowering Healthcare Professionals, Enriching Lives Requirements Qualifications: • Education: Graduate of an accredited dental hygiene program, • Licensure: Active New York State Dental Hygienist credential/registration, • Experience: Must have a minimum of 2 years of experience in the provision of clinical services or in quality improvement/utilization reviews. Experience in pediatrics is required., • Soft Skills:, • Must have the ability to work independently with minimal supervision, as well as in a team environment., • Must have strong interpersonal skills with the ability to relate effectively with clinical and administrative personnel., • Must have strong communication skills (written and verbal)., • Must have the ability to travel to on-site review assignments.

Job Description VICP/CICP Medical Case Reviewer – Physician (MD/DO) - Remote (#R10246) Location: Remote (U.S.) Employment Type: Contract (Case-Based Consulting) Hourly Rate: $127.05/hour About Greenlife Healthcare Staffing: Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals. Position Overview: Greenlife Healthcare Staffing is seeking a Medical Case Reviewer (Physician) to conduct detailed reviews of vaccine and countermeasure injury claims, assesses causation and eligibility under statute, and prepare written recommendations for the VICP and CICP. Why Join Us? • Competitive Compensation: $127.05/hour, • Work Schedule: Flexible, case-based consulting, • Professional Growth: Influence federal vaccine injury compensation Job qualifications & certifications: • MD or DO from accredited U.S. (or equivalent foreign) medical school., • Current, active, full, unrestricted medical license in a U.S. state/territory/DC/PR., • At least 5 years of experience reviewing cases related to vaccine administration and vaccine injury., • Subject-matter expertise in a relevant specialty (e.g., Pediatrics, Neurology, Immunology, Internal Medicine, Infectious Disease, etc.), supported by clinical practice and/or academic work., • Experience with injury-compensation or medical claims-review programs., • Prior participation in multidisciplinary case review panels., • Demonstrated subject-matter expertise supported by peer-reviewed publications, research, and/or academic teaching., • Ability to pass a National Practitioner Data Bank (NPDB) query with no disqualifying adverse actions., • Review petitions, medical records, affidavits, depositions, and exhibits for adequacy of information and likelihood of vaccine causation., • Analyze associated diseases/conditions and applicable medical literature., • Prepare draft and final case review reports that:, • Identify essential issues, • Assess eligibility under the Vaccine Injury Table, • Evaluate preponderance of evidence for factors unrelated or alternate causation, • Incorporate outside consultations when needed, • Consult with Team Lead, medical experts, HHS Office of General Counsel, and DOJ attorneys., • Present cases and participate in panel discussions to reach consensus on recommendations., • Manage assigned cases from initial review through final adjudication. Greenlife Healthcare Staffing - Empowering Healthcare Professionals, Enriching Lives.

Job Description About Cleerly We're Cleerly – a healthcare company that's revolutionizing how heart disease is diagnosed, treated, and tracked. We were founded in 2017 by one of the world's leading cardiologists and are a growing team of world-class engineering, operations, medical affairs, marketing, and sales leaders. We raised $223M in Series C funding in 2022 which has enabled rapid growth and continued support of our mission. In December 2024 we received an additional $106M in a Series C extension funding. Most of our teams work remotely and have access to our offices in Denver, Colorado, New, York, New York, Dallas, Texas, and Lisbon, Portugal with some roles requiring you to be on-site in a location. Cleerly has created a new standard of care for heart disease through value-based, AI-driven precision diagnostic solutions with the goal of helping prevent heart attacks. Our technology goes beyond traditional measures of heart disease by enabling comprehensive quantification and characterization of atherosclerosis, or plaque buildup, in each of the heart arteries. Cleerly's solutions are supported by more than a decade of performing some of the world's largest clinical trials to identify important findings beyond symptoms that increase a person's risk of heart attacks. At Cleerly, we collaborate digitally and use a wide variety of systems. Our people use Google Workspace (GMail, Drive, Docs, Sheets, Slides), Slack, Confluence/Jira, and Zoom Video, prior experience in these areas is a plus. Role or department specific technology needs may vary and will be listed as requirements in the job description. While we are mostly a remote company, travel is required for some team meetings and cross function projects typically once per month or once per quarter, for some roles like sales or external facing roles travel could be up to 90% of the time. About the Opportunity Cleerly's services are rapidly scaling up, and we are seeking a highly organized leader with deep experience in cardiac imaging research, core lab operations, and clinical education to serve as the Director, Physicians Org. In this multifaceted role, you will be the primary organizer, educator, and overreader for the US Physicians Org. You will provide expert oversight, direct contract physician overreaders, and ensure the operational and quality compliance of our CCTA analysis processes. This position is ideal for an experienced researcher passionate about applying clinical rigor, organizational structure, and educational programs to scale impact in a fast-paced, technology-driven environment. TTC*: $245,295 - $342,815 *Total Target Compensation (TTC): Total Cash Compensation (including base pay, variable pay, commission, bonuses, etc.). We hire employees anywhere within the United States and account for geography when determining base salary. Each role at Cleerly has a defined salary range based on market data and company stage. We typically hire at the lower to mid-point of the range, with the top end reserved for internal growth and exceptional performance. Actual pay depends on factors like experience, technical depth, geographic location, and alignment with internal peers. Responsibilities Physicians Org Organization, Quality & Administration * • H: Humility- be a servant leader, • E: Excellence- deliver world-changing results, • A: Accountability- do what you say; expect the same from others, • R: Remarkable- inspire & innovate with impact OUR COMPANY IS AN EQUAL OPPORTUNITY EMPLOYER. We do not discriminate on the basis of race, color, national origin, ancestry, citizenship status, protected veteran status, religion, physical or mental disability, marital status, sex, sexual orientation, gender identity or expression, age, or any other basis protected by law, ordinance, or regulation. By submitting your application, you agree to receive SMS messages from Cleerly recruiters throughout the interview process. Message frequency may vary. Message and data rates may apply. You can STOP messaging by sending STOP and get more help by sending HELP. For more information see our Privacy Policy (). All official emails will come from @cleerlyhealth.com email accounts. #Cleerly

Job Description Dane Street is expanding our physician panel! This is a telework opportunity for supplemental income for physicians providing a caseload customized to your schedule. Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case basis. The ideal candidates will hold a NY license and be Board Certified in Orthopedic Surgery, with experience in completing Independent Medical Exams. The ideal candidate will be New York State Workers' Comp certified. Independent Medical Exams are available to be completed across the state of New York. Requirements As Physician Reviewer/Advisor, you will utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client specific policies, nationally recognized evidence-based guidelines, and standards of care. MAJOR DUTIES AND RESPONSIBILITIES: • Reviews all medical records and addresses each question posed by the client utilizing client specific criteria or other nationally recognized evidence-based criteria, • Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision, • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes, • Provides copies of any criteria utilized in a review with the report in a timely manner, • Returns cases on or before the due date and time, • Makes telephone calls as mandated by the state and/or client specifics, • Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job, • Attends all required orientation and training, • Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits, • Board certification required, active practice required PLEASE BE AWARE: In the interest of the security of all parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason including the purchase of equipment. Benefits Robust opportunity for supplemental income • Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability, • No doctor/patient relationship is established and no treatment is provided. These are advisory-only opinions., • Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management expertise, • Expanded credentials as an expert in Independent Medical Exams and physician advisor services, • Fully prepped cases, streamlined case flow, transcription services at no cost, and user-friendly work portal Dane Street supports all referral processes, scheduling, preps cases extensively, prepares all medical records, provides transcription services as applicable, facilitates all client communications, and ensures the quality and timeliness of all reports and report delivery. Apply for this job

Job Description Dane Street is expanding our physician panel! This is a telework opportunity for supplemental income for physicians providing a caseload customized to your schedule. Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case basis. The ideal candidates will hold a NY license and be Board Certified in Neurology with experience in completing Independent Medical Exams. The ideal candidate will be New York State Workers' Comp certified. Independent Medical Exams are available to be completed across the state of New York. Requirements As Physician Reviewer/Advisor, you will utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client specific policies, nationally recognized evidence-based guidelines, and standards of care. MAJOR DUTIES AND RESPONSIBILITIES: • Reviews all medical records and addresses each question posed by the client utilizing client specific criteria or other nationally recognized evidence-based criteria, • Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision, • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes, • Provides copies of any criteria utilized in a review with the report in a timely manner, • Returns cases on or before the due date and time, • Makes telephone calls as mandated by the state and/or client specifics, • Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job, • Attends all required orientation and training, • Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits, • Board certification required, active practice required PLEASE BE AWARE: In the interest of the security of all parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason including the purchase of equipment. Benefits Robust opportunity for supplemental income • Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability, • No doctor/patient relationship is established and no treatment is provided. These are advisory-only opinions., • Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management expertise, • Expanded credentials as an expert in Independent Medical Exams and physician advisor services, • Fully prepped cases, streamlined case flow, transcription services at no cost, and user-friendly work portal Dane Street supports all referral processes, scheduling, preps cases extensively, prepares all medical records, provides transcription services as applicable, facilitates all client communications, and ensures the quality and timeliness of all reports and report delivery. Apply for this job

Clinical Quality Reviewer – Seasonal. Clinical Quality Reviewer - Hybrid. Clinical background: Health Educator, LPN, RN, LMSW, or LCSW.

Paying $63 an hour Position Overview: The primary function of the Clinical Quality Reviewer - Seasonal is to conduct audit of medical charts for compliance with HEDIS, QARR, Medicare Advantage Star measure specifications. TOP HEALTH INSURANCE COMPANY NOW HIRING CLINICAL QUALITY REVIEWER Located in

Clinical background: Health Educator, LPN, RN, LMSW, or LCSW Minimum 2 years of HEDIS review experience in a managed care or health plan setting Experience with medical record review for HEDIS/QARR measures Licensure/Certification Required: Health Educator, LPN, RN, LMSW, or LCSW with ≥2 years HED

Clinical Quality Reviewer - Hybrid.

Job Description & Requirements.Neonatology Nurse Practitioner (NP).StartDate: ASAP Available Shifts: 24 Pay Rate: $97.This facility is seeking a Neonatology Nurse Practitioner (NP) for locum tenens support as they look to fill a current need.Details & requirements for this opportunity:.Job Setting:

Job Description & Requirements.Hematology - Oncology Nurse Practitioner (NP).StartDate: ASAP Available Shifts: 8 Pay Rate: $101.This facility is seeking a Hematology - Oncology Nurse Practitioner (NP) for locum tenens support as they look to fill a current need.Details and requirements for this

Company Description At Inwood Animal Clinic, we specialize in quality veterinary care for pets of all ages.We are available to address any potential issues, so our patients will enjoy a lifetime of great health.Our goal is to deliver top-quality care for every animal that walks through our doors.We'

Licensed Clinical Social Worker LCSW - Bilingual Spanish Speaking Are you passionate about working with an underserved and rewarding population? Looking for a clinical role without the administrative burden, and one that offers real work-life balance? If so, read on and apply today! Senior Care Ther

Our team members are the heart of what makes us better.At Hackensack Meridian we help our patients live better, healthier lives - and we help one another to succeed.With a culture rooted in connection and collaboration, our employees are team members.Here, competitive benefits are just the

Licensed Clinical Social Worker LCSW - Bilingual Spanish Speaking Are you passionate about working with an underserved and rewarding population? Looking for a clinical role without the administrative burden, and one that offers real work-life balance? If so, read on and apply today! Senior Care Ther

We encourage you to reach out directly to learn more about current openings! Currently Hiring for Clinical Psychologist, LCSW, LPC, LMHC, and LMFT located in NJ, NY, PA, or MD. Are you passionate about working with an underserved and rewarding population? Looking for a clinical role without the admi

Licensed Clinical Social Worker LCSW Are you passionate about working with an underserved and rewarding population? Looking for a clinical role without the administrative burden, and one that offers real work-life balance? If so, read on and apply today! Senior Care Therapy is seeking full-time or p

Licensed Clinical Social Worker LCSW. Are you passionate about working with an underserved and rewarding population? Looking for a clinical role without the administrative burden, and one that offers real work-life balance? If so, read on and apply today!. Senior Care Therapy is seeking full-time or

Licensed Clinical Social Worker LCSW Are you passionate about working with an underserved and rewarding population? Looking for a clinical role without the administrative burden, and one that offers real work-life balance? If so, read on and apply today! Senior Care Therapy is seeking full-time or p

Licensed Clinical Social Worker LCSW. At SCT, we handle all the administrative responsibilities -- including billing, insurance, credentialing, and pre certifications --- so you can do what you do best: providing exceptional clinical care!. We encourage you to reach out directly to learn more about

Licensed Clinical Social Worker LCSW - Bilingual Spanish Speaking Are you passionate about working with an underserved and rewarding population? Looking for a clinical role without the administrative burden, and one that offers real work-life balance? If so, read on and apply today! Senior Care Ther

Licensed Clinical Social Worker (LCSW). Licensed Clinical Social Worker — Are you ready to launch or expand your private practice?. You're a fully-licensed Clinical Social Worker at a Master's level or above with LCSW, LICSW, or LCSCW licensure (accepted on a state by state basis), a valid NPI num

What We Provide Referral bonus opportunities Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability Employer-matched retirement saving funds Personal and financial welln

Northwell Health - 11 East 86th St #1B [Medical Office Assistant] As a Receptionist at Northwell Health, you'll: Perform a variety of duties relative to admission, discharge and/or transfer of patients; Perform a variety of clerical duties required to maintain accurate charts; Perform a variety of c

Hackensack Meridian Health - JobID: J7ba634658dfc4a71a25c0fd195c2171f-1 [Medical Office Assistant] As a Medical Receptionist at Hackensack Meridian Health, you'll: Greet patients and visitors warmly, ensuring a welcoming environment; Schedule appointments efficiently, managing calendars and patient

Clinical Team Support: peer-to-peer learning. Maintain accurate and timely clinical documentation in accordance with regulatory standards using our clinician-designed electronic medical/health system (EHR). Active and unrestricted license to practice as a Licensed Clinical Social Worker in State app

Hackensack Meridian Health - JobID: J4d1c89d8e0184ce990420502060bfd34-1 [Medical Office Assistant] As a Medical Receptionist at Hackensack Meridian Health, you'll: Greet patients and visitors warmly, ensuring a welcoming environment; Schedule appointments efficiently, managing calendars and patient

Licensed Clinical Social Worker LCSW -. Are you passionate about working with an underserved and rewarding population? Looking for a clinical role without the administrative burden, and one that offers real work-life balance? If so, read on and apply today!. Senior Care Therapy is seeking full-time

Hackensack Meridian Health - JobID: Je47d80478ecc4b1aba8d92ff4582bf76-1 [Medical Office Assistant] As a Medical Receptionist at Hackensack Meridian Health, you'll: Greet patients and visitors warmly, ensuring a welcoming environment; Schedule appointments efficiently, managing calendars and patient

At SCT, we handle all the administrative responsibilities -- including billing, insurance, credentialing, and pre certifications --- so you can do what you do best: providing exceptional clinical care!. Clinical Team Support: peer-to-peer learning. Maintain accurate and timely clinical documentation

Hackensack Meridian Health - JobID: J8ca3f87d98a44b9b865a0aa7b6651f48-1 [Medical Office Assistant] As a Medical Receptionist at Hackensack Meridian Health, you'll: Greet patients and visitors warmly, ensuring a welcoming environment; Schedule appointments efficiently, managing calendars and patient

Fordham Dermatology is a medical practice located at 553 E Fordham Rd, Bronx, New York, United States.This is a full-time on-site role for a Medical Office Receptionist at Fordham Dermatology in Bronx, NY.The Medical Office Receptionist will be responsible for phone etiquette, appointment scheduling

Hackensack Meridian Health - JobID: J530f14c1c4a4429d88c94bbbb91ace00-1 [Medical Office Assistant] As a Medical Receptionist at Hackensack Meridian Health, you'll: Greet patients and visitors warmly, ensuring a welcoming environment; Schedule appointments efficiently, managing calendars and patient

What We Provide Referral bonus opportunities Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability Employer-matched retirement saving funds Personal and financial welln

Hackensack Meridian Health - JobID: Jd002945f8f3744309e762ef18bddb518-1 [Medical Office Assistant] As a Medical Receptionist at Hackensack Meridian Health, you'll: Greet patients and visitors warmly, ensuring a welcoming environment; Schedule appointments efficiently, managing calendars and patient

Unit Receptionist - Administrative.MUST HAVE THOROUGH TIMEKEEPING EXP.Must have thorough knowledge of office equipment & supplies & typing of at least 60wpm gained through at least 1 yr clerical exp or graduation from commercial/secretarial school.Good organizational, oral & written comm

Hackensack Meridian Health - JobID: J736a97402f8c47469dd0e5c47a8f84ca-1 [Medical Office Assistant] As a Medical Receptionist at Hackensack Meridian Health, you'll: Greet patients and visitors warmly, ensuring a welcoming environment; Schedule appointments efficiently, managing calendars and patient

Initiates and maintains verbal and written communication according to VNS Home Care policy, including the preparation of clinical and progress notes, to ensure optimal quality care. Licenses and Certifications: Current registration to practice as a Licensed Social Worker in New York State required o

Clinical hours are provided to Social Workers.

May provide clinical supervision for Mental Health Technician, graduate Social Worker students or junior staff Social Workers.

LMSWs with 1-5 years of clinical experience.

Ensure clinical and administrative compliance in all program areas. Other clinical duties, as assigned.

Initiates and maintains verbal and written communication according to VNS Home Care policy, including the preparation of clinical and progress notes, to ensure optimal quality care. Licenses and Certifications: Current registration to practice as a Licensed Social Worker in New York State required o

Are you passionate about working with an underserved and rewarding population? Looking for a clinical role without the administrative burden, and one that offers real work-life balance? If so, read on and apply today!. Active and unrestricted license to practice as a Licensed Clinical Social Worker

Compiles clinical assessment forms and documentation and prepares clinical assessment reports as required by HRA. Participates in team meetings to evaluate and improve clinical assessment processes, including providing input to the design of any clinical assessment forms. Works collaboratively with

Clinical hours are provided to Social Workers.