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We’re unique. You should be, too. We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy? We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team. The Physician Reviewer is the primary physician reviewer for Clinical Appropriateness Reviews cases in our organization. Other duties include advising other physician reviewers and attending daily calls with health plan teams and our local teams assisting with this function and coordinating care for our patients. The position will also participate in Process and Quality improvement in our developing area of Delegated Utilization Management. • Provides Clinical Appropriateness Reviews by covering the specified territories as assigned:, • Establish 2-3 cases a day for each market covered (up to 6 markets); ensures attendance on all health plan and local calls; calls in for the weekly Primary Care Provider (PCP) and Skilled Nursing Facility (SNF) meetings covering the assigned territories., • Advises other physician reviewers., • Other duties as assigned and modified by manager., • Excellent analytical and deductive reasoning skills, • Good judgement and problem-solving skills, • Professional and effective communication skills, • Strong organizational skills, • Written and verbal fluency in English, • Proficient in the use of Microsoft Office products such as Outlook, Excel, Word and PowerPoint, • Graduate from accredited Medical School with a valid, unrestricted license is required, • Completion of Internal Medicine or Family Practice residency, • Completion of Fellowship in Gastroenterology, • Board Certification in residency area, • Board Certification in Gastroenterology, • Two (2) years’ experience in Hospital medicine preferred, • At least one (1) year of utilization review experience preferred PAY RANGE: $204,761 - $292,515 Salary The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions. EMPLOYEE BENEFITS _ We’re ChenMed and we’re transforming healthcare for seniors and changing America’s healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We’re growing rapidly as we seek to rescue more and more seniors from inadequate health care. ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people’s lives every single day. Current employees, if you want to apply to our internal career site, please click _ Current Contingent Worker please see job aid _ to apply #LI-Remote

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Nurse Reviewer I Virtual : 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 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. Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center-connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together. Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data scientists, and other dedicated and caring health professionals. While our roles may differ, our purpose is shared: to make a positive impact on whole health. Schedule: 9:30am-6:00pm local time, with rotating weekends. New Grads are encouraged to apply! The Nurse Reviewer I will be responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. Partners with more senior colleagues to complete non-routine reviews. Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. How you will make an impact: Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. Notifies ordering physician or rendering service provider office of the preauthorization determination decision. Follows-up to obtain additional clinical information. Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics. Minimum ?Requirements: AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities, and Experiences?: Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO and POS plans strongly preferred. BA/BS degree preferred. Previous utilization and/or quality management and/or call center experience preferred. Knowledge in Microsoft office. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $33.92/hr. - $58.15/hr. Locations: New York, New Jersey, Washington, Nevada, Maryland, Massachusetts, Illinois. In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. • The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/) .

The Physician Reviewer is the primary physician reviewer for Utilization Management (UM) cases in our organization. Advises other physician reviewers. Other duties include advising other physician reviewers and attending daily calls with health plan teams and our local teams assisting with this func

Licensed Psychiatric Nurse Practitioner.Wage: Between $156-$206 an hour.Did you know that you can build a flexible private practice on your terms as a psychiatric nurse practitioner?.Whether you want to see patients alongside a full-time job or grow a full-time practice, Headway makes it easy to acc

Diagnose and treat both acute and chronic conditions, collaborating effectively with physicians or working independently as required.

Licensed Psychiatric Nurse Practitioner.Wage: Between $156-$206 an hour.Did you know that you can build a flexible private practice on your terms as a psychiatric nurse practitioner?.Whether you want to see patients alongside a full-time job or grow a full-time practice, Headway makes it easy to acc

Collaborate closely with physicians and interdisciplinary team members to ensure coordinated, efficient care, and participate in care plan meetings and quality improvement efforts.

Licensed Psychiatric Nurse Practitioner.Wage: Between $156-$206 an hour.Did you know that you can build a flexible private practice on your terms as a psychiatric nurse practitioner?.Whether you want to see patients alongside a full-time job or grow a full-time practice, Headway makes it easy to acc

Candidates must reside within close proximity to a major airport.Traditional travel nursing often requires moving from contract to contract, repeatedly onboarding into new hospital systems, and coordinating housing and logistics for each assignment.At Milan Laser Hair Removal, our Traveling Provider

Diagnosing and treating acute, chronic, or episodic illnesses independently or in collaboration with physicians (according to credentialing).

Aesthetic Nurse Practitioner or Physician Assistant Miami Florida Job#16653490. We are seeking a full-time Bilingual Aesthetic Nurse Practitioner or Physician Assistant to join Medical Clinic in Southeast Miami Florida. Must have a current Nurse Practitioner or Physician Assistant license in the sta

Diagnosing and treating acute, episodic, or chronic conditions, in partnership with physicians or independently (as per credentialing).

Join LaserAway as an Aesthetic Nurse Practitioner - Elevate Your Career in Aesthetic Dermatology!.Are you passionate about aesthetics, committed to patient care, and excited to work in a cutting-edge clinical environment? LaserAway, the industry leader with over 10 million treatments performed and 1

Diagnosing and treating acute, episodic, or chronic conditions in partnership with physicians or autonomously, depending on your qualifications.

Diagnosing and managing acute, episodic, or chronic health conditions in partnership with physicians or independently (following your certification).

Understands when a member's needs are beyond their scope of knowledge and when physician oversight is needed. Engages in practices constituting the practice of medicine in collaboration with and under the medical direction and supervision of a licensed physician to the degree required by state laws.

Maintains contact with other clinical team members, patients' other physicians and patients' other medical providers to coordinate optimal care and resources for the patient and his or her family in a timely basis and consistent with state regulations and company health standards and policy.

Diagnose and manage acute, chronic, or episodic health conditions alongside collaborative physicians or independently (based on credentials).

Aesthetics Injectables Nurse Practitioner Or Physician Assistant Injector - Miami, Florida. A premier Med Spa in South Florida is seeking an experienced Nurse Practitioner or Physician Assistant Injector to join their expanding cosmetic dermatology practice, specializing in non-invasive procedures.

Diagnosing and managing acute, episodic, or chronic ailments independently or in sync with physicians (depending on credentialing).

Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. In collaboration with super

Diagnose and treat both acute and chronic conditions, collaborating effectively with physicians or working independently as required.

Collaborate closely with physicians and interdisciplinary team members to ensure coordinated, efficient care, and participate in care plan meetings and quality improvement efforts.

Diagnosing and treating acute, chronic, or episodic illnesses independently or in collaboration with physicians (according to credentialing).

Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. In collaboration with super

It's rewarding to be on a team of people that truly believe in making an impact!.We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us.Operating medical centers across Florida, Cano Health prioritizes patient well-being through

Thomas University College of Nursing is seeking a certified Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP) to provide online instruction and academic support to graduate nursing students enrolled in the Adult-Gerontology Primary Care Nurse Practitioner program.The successful candidate wi

Diagnosing and treating urgent, episodic, or chronic conditions in collaboration with physicians or independently, guided by credentialing.

Nurse Practitioners will work in collaboration with a dedicated clinical care team to provide evidenced-based care to a panel of patients.The clinical care team will work with the provider daily to drive better outcomes for entire panel of patients.This will include accurate assessment, diagnosis, t

Aesthetic Nurse Practitioner - $55/hr + $5/hr Weekend Differential.Fixed Schedule | No Overnights | Comprehensive Training Provided.LaserAway is the nation's leader in aesthetic dermatology.We specialize in advanced, non-surgical treatments that combine medical expertise and cutting-edge technology

Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. In collaboration with super

Aesthetic Nurse Practitioner for MedSpa Miami Florida Job#16654429.We are seeking a full-time experienced Aesthetic Nurse Practitioner to join our Med Spa in Miami Florida.Must have experience with medical aesthetic injectables such as Botox, fillers, facials, IV administration and laser treatments.

Neonatal Nurse Practitioner Opportunity.Pediatrix® Medical Group seeks an experienced, per diem, certified Neonatal Nurse Practitioner to join our South Florida team of Neonatologists and NNPs in providing high-quality, compassionate care at HCA Florida Mercy Hospital.NICU at both Mercy Hospital an

Our client is a physician-led pediatric practice with multiple locations and a collaborative team of physicians and mid-level providers.

Medical Nurse Practitioner or Physician Assistant.

Our team of mental health professionals includes psychiatrists, clinical psychologists/neuropsychologists, board-certified psychiatric nurse practitioners, certified physician assistants, and licensed therapists.

In the role of an Advanced Care Provider (Physician Assistant/Nurse Practitioner) you will provide concierge emergency medical care to Sollis Health patients in our clinics as well as conduct concierge medical at home visits to Sollis Health patients and treat them accordingly, with the supervision/

Our team of mental health professionals includes psychiatrists, clinical psychologists/neuropsychologists, board-certified psychiatric nurse practitioners, certified physician assistants, and licensed therapists.

Identifying and managing acute, chronic, and episodic health conditions in partnership with physicians or independently, based on your credentials.

Takes part in patient rounds with the responsible physicians as necessary. Assists in the coordination of patient imaging studies and laboratory tests required for specific Interventional radiology tests and procedures through contact with the referring physicians and/or the patients directly. Assis

You'll join a deeply collaborative environment, with access to physician partners, therapists, and crisis support services. Collaborate with physicians and clinical leadership for support, escalation, and continued learning.

Diagnose and manage acute, episodic, or chronic health issues in partnership with physicians or independently, depending on your credentials.