Data reviewer jobs in Linden, New JerseyCreate job alerts

Job Description Overview Are you an accomplished Board Certified Spine Surgeon or Board Certified Neurosurgeon? Are you passionate about your work/life balance? We are seeking flexible and experienced physicians for our medical reviewstream division. This telecommute role provides the ability for you to customize your schedule and caseload within a Monday - Friday work week and within business hours. Create a flexible work schedule and be compensated on a per case basis as a 1099 independent contractor. Candidates must have a NJ license. JOB SUMMARY: Relying on clinical background, reviews health claims providing medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with Concentra Physician Review policies, procedures, and performance standards and URAAC guidelines and state regulations. Responsibilities MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers’ compensation claims., • Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues., • Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job., • Returns cases in a timely manner with clear concise and complete rationales and documented criteria., • Telephonically contacts providers and interacts with other health professionals in a professional manner. Discusses the appropriate disclaimers and appeal process with the providers., • Attends orientation and training, • Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits., • 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., • Provides copies of any criteria utilized in a review to a requesting provider in a timely manner Qualifications EDUCATION/CREDENTIALS: -Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services. -Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. -Must be in active medical practice to perform appeals JOB-RELATED EXPERIENCE: Post-graduate experience in direct patient care JOB-RELATED SKILLS/COMPETENCIES: -Demonstrated computer skills, telephonic skills -Demonstrated ability to perform review services. -Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals. -Medical direction shall also be provided consistent with the requirement that the physician advisor shall not have a financial conflict of interest -Must present evidence of current error and omissions liability coverage for job duties and activities performed -Managed care orientation -Knowledge of current practice standards in specialty -Good negotiation and communication skills WORKING CONDITIONS/PHYSICAL DEMANDS: -Phone accessability -Access to a computer to complete reviews -Ability to complete cases accompanied by a typed report in specified time frames -Telephonic conferences This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management. Concentra is an Equal Opportunity Employer M/F/Disability/Veteran Concentra's Data Protection Commitment • Concentra is committed to protect patient data and to ensure privacy of personal and medical information., • Every Concentra colleague has the responsibility to adhere to data protection principles., • If a colleague's role includes handling or processing sensitive data, role-specific policies and requirements apply to ensure the protection of patient information.

Job Description Overview Are you an accomplished Board Certified Neurosurgeon? Are you passionate about your work/life balance? We are seeking flexible and experienced physicians for our medical reviewstream division. This telecommute role provides the ability for you to customize your schedule and caseload within a Monday - Friday work week and within business hours. Create a flexible work schedule and be compensated on a per case basis as a 1099 independent contractor. Candidates must have a NJ license. JOB SUMMARY: Relying on clinical background, reviews health claims providing medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with Concentra Physician Review policies, procedures, and performance standards and URAAC guidelines and state regulations. Responsibilities MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers’ compensation claims., • Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues., • Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job., • Returns cases in a timely manner with clear concise and complete rationales and documented criteria., • Telephonically contacts providers and interacts with other health professionals in a professional manner. Discusses the appropriate disclaimers and appeal process with the providers., • Attends orientation and training, • Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits., • 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., • Provides copies of any criteria utilized in a review to a requesting provider in a timely manner Qualifications EDUCATION/CREDENTIALS: -Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services. -Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. -Must be in active medical practice to perform appeals JOB-RELATED EXPERIENCE: Post-graduate experience in direct patient care JOB-RELATED SKILLS/COMPETENCIES: -Demonstrated computer skills, telephonic skills -Demonstrated ability to perform review services. -Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals. -Medical direction shall also be provided consistent with the requirement that the physician advisor shall not have a financial conflict of interest -Must present evidence of current error and omissions liability coverage for job duties and activities performed -Managed care orientation -Knowledge of current practice standards in specialty -Good negotiation and communication skills WORKING CONDITIONS/PHYSICAL DEMANDS: -Phone accessability -Access to a computer to complete reviews -Ability to complete cases accompanied by a typed report in specified time frames -Telephonic conferences This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management. Concentra is an Equal Opportunity Employer M/F/Disability/Veteran Concentra's Data Protection Commitment • Concentra is committed to protect patient data and to ensure privacy of personal and medical information., • Every Concentra colleague has the responsibility to adhere to data protection principles., • If a colleague's role includes handling or processing sensitive data, role-specific policies and requirements apply to ensure the protection of patient information.

Job Description Overview Are you an accomplished Board Certified Physical Medicine and Rehabilitation? Are you passionate about your work/life balance? We are seeking flexible and experienced physicians for our medical reviewstream division. This telecommute role provides the ability for you to customize your schedule and caseload within a Monday - Friday work week and within business hours. Create a flexible work schedule and be compensated on a per case basis as a 1099 independent contractor. Candidates must have a NJ license. JOB SUMMARY: Relying on clinical background, reviews health claims providing medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with Concentra Physician Review policies, procedures, and performance standards and URAAC guidelines and state regulations. Responsibilities MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers’ compensation claims., • Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues., • Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job., • Returns cases in a timely manner with clear concise and complete rationales and documented criteria., • Telephonically contacts providers and interacts with other health professionals in a professional manner. Discusses the appropriate disclaimers and appeal process with the providers., • Attends orientation and training, • Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits., • 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., • Provides copies of any criteria utilized in a review to a requesting provider in a timely manner Qualifications EDUCATION/CREDENTIALS: -Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services. -Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. -Must be in active medical practice to perform appeals JOB-RELATED EXPERIENCE: Post-graduate experience in direct patient care JOB-RELATED SKILLS/COMPETENCIES: -Demonstrated computer skills, telephonic skills -Demonstrated ability to perform review services. -Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals. -Medical direction shall also be provided consistent with the requirement that the physician advisor shall not have a financial conflict of interest -Must present evidence of current error and omissions liability coverage for job duties and activities performed -Managed care orientation -Knowledge of current practice standards in specialty -Good negotiation and communication skills WORKING CONDITIONS/PHYSICAL DEMANDS: -Phone accessability -Access to a computer to complete reviews -Ability to complete cases accompanied by a typed report in specified time frames -Telephonic conferences This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management. Concentra is an Equal Opportunity Employer M/F/Disability/Veteran Concentra's Data Protection Commitment • Concentra is committed to protect patient data and to ensure privacy of personal and medical information., • Every Concentra colleague has the responsibility to adhere to data protection principles., • If a colleague's role includes handling or processing sensitive data, role-specific policies and requirements apply to ensure the protection of patient information.

Job Title: Salesforce Project Manager.Location: NY/NJ (Hybrid – 3 days/week).Seeking a Senior Project Manager to lead Salesforce B2B delivery projects, managing end-to-end execution, stakeholders, and cross-functional teams.Manage multiple Salesforce projects (scope, timeline, budget).Drive projec

Are you passionate about making a difference in the world? Look no further! The Borgen Project is an international organization that works at the political level to improve living conditions for people impacted by war, famine and poverty.With 20 years of experience in the advocacy space, The Borgen

Competitive pay / $500 retention bonus / Medical, dental, and vision / 401K / PTO / Equipment provided / Paid training - As a Call Center Support Rep you'll: Receive a large volume of inbound phone calls; Assist with outbound call campaigns; Answer general questions and transfer calls to other depar

Flex Schedule 7a-11p EST / Medical-Dental-Vision-Life-AD&D / 401(k) +3% / Generous PTO + Parental Leave - As a FT - Call Center Representative - Work From Home at Lap Of Love, you will: Assist clients with their end-of-life care needs by answering phone calls and providing compassionate and empathet

Customer Service / Remote] - Anywhere in U.DOE / Health-Dental-Vision-Life-FSA-HSA / 401(k) plan - As a Call Center Representative, you will: Assist customers with inquiries and concerns through multiple communication channels including phone, email, and chat; Provide exceptional customer service by

As a FT Call Center/Customer Service Rep [Work From Home], you will: Handle incoming calls and inquiries from customers in a professional and courteous manner; Provide accurate and efficient assistance with customer inquiries, complaints, and requests; Maintain a high level of product knowledge to e

Call Center / Remote] - Anywhere in U.Competitive pay / Medical, dental & vision / 401k / PTO - As a Customer Service Rep at Planet Home Lending, you will: Respond to borrower inbound calls concerning their account, ensuring high quality service and adhering to productivity and regulatory requiremen

Customer Service Representative.LHH is partnering with a wellness services organization to hire a temp to permanent Customer Service Representative.This role is fully in office with hours from 9AM to 5:30PM with a 30-minute break, Monday through Friday.The qualified candidate should have at least 2

Seeking participants for Focus Group and market research studies.Work part-time from home and earn up to $750 per week.Register to see if you are eligible.Customer service representative agent experience not required.Remote Work From Home Customer Service Representative Agent - Part Time Market Rese

Customer Support / Remote] - Anywhere in U.Medical, dental & vision / PTO / Paid training - As a Customer Service Rep at Assurant, you will: Handle inbound customer calls and/or e-mails with empathy and professionalism; Resolve issues, answer questions, and provide proactive solutions; Document inte

Bank Clothiers - 1301 Springfield Ave.Irvington, NJ, United States, 07111 [Customer Service Representative] As a Customer Service Representative at JoS.Bank Clothiers, you'll: Handle and accurately follow standard operating procedures for all customer purchases, returns, exchanges, store credits and

Customer Support / Remote] - Anywhere in U.Medical, dental & vision / 401k - As a Customer Service Rep at DGI Supply, you will: Handle customer and sales interactions via phone, email and tickets within the Customer Care Box; Process requests for quotations, order entry and product questions from cu

Bank Clothiers - 463 Green Street, Woodbridge, NJ, United States, 07095 [Customer Service Representative] As a Customer Service Representative at JoS.Bank Clothiers, you'll: Handle and accurately follow standard operating procedures for all customer purchases, returns, exchanges, store credits and d

Enterprise - JobID: 543561 [Reservation Agent / Front Desk] As a Customer Service Rep at Enterprise, you'll: Take incoming calls- reservations, rate quotes, questions, etc; Provide information and resolution for customers; Manage outgoing calls for callback management, A/Rs and miscellaneous calls a