Initial Clinical Reviewer Job at Blue Cross Blue Shield of Arizona (Phoenix)

Client Partner for Clinical Review

Give your career a boost by joining us a Client Partner - Clinical Review for Pr...

Location

Philippines , Taguig City

Salary:

Not provided

Access Healthcare LLC

Expiration Date

Until further notice

Requirements

Ability to type at least 30 WPM
Possess basic computer knowledge
Good verbal and written communication skills
Willing to work in the night shift at our office in McKinley Hill, Taguig
Available to join immediately for full time position
Candidate must possess a Bachelor’s degree in any medical allied courses such as Nursing, Radiology, Pharmacy, Nutrition and Dietetics, Psychology, Medical Transcription, Biology, Chemistry, Medical Technology, Physical Therapy or Midwifery
Experience in a BPO healthcare setting an advantage

Job Responsibility

Be thoroughly familiar with the day-to-day activities of the Pre-Authorization process
Show the zeal and drive to learn, take initiative in equipping one-self through induction & client-specific training
Secondary level training with test scores
Update continuously your knowledge related to your client by going through mails, Knowledge Management portal
Understand the workflow process that is taking place through our IT systems
Should focus and achieve on the set targets and cooperate with the respective team in achieving the set Turn around Timekeeping a high accuracy level
Treats all patient and client information as confidential
Follow processing and client-related protocols
Process transactions as specified by Team Leader/Assistant Manager
Follow Information Security Policy and Compliance requirements including regulatory compliances

Fulltime

Senior Physician, Patient Safety

Join our dynamic Patient Safety team as a Senior Physician where you'll leverage...

Location

United States; Canada , Remote; Alberta

Salary:

Not provided

Parexel

Expiration Date

Until further notice

Requirements

Experience in clinical medicine (general or specialist qualifications) which is expected to be kept up to date
Good knowledge of drug safety and the drug development process
Good knowledge/understanding of medical terminology
Relevant experience in pharmacovigilance/ Drug Safety/ Clinical Practice
3 - 5 years previous experience in pharmacovigilance and/or medical monitoring is required
US Board Certification/board eligibility or regional equivalent for Canada
Bachelor of Medicine, Bachelor of Surgery (MBBS) / Doctor of Medicine (MD)/ Medically qualified from an acknowledged Medical School
Completion of at least basic training in clinical medicine (residency, internship etc.)
Demonstrated success in technical proficiency and scientific creativity
Good presentation and verbal/written communication skills

Job Responsibility

Maintaining a good working knowledge of the Adverse event/Safety profile of assigned products, labeling documents, data handling conventions, client’s guidelines and procedures, and global drug safety regulations and guidelines
Maintaining an awareness of global regulatory requirements, reporting obligations and organizing workload to ensure compliance with internal and regulatory timelines for adverse event reporting
Performing medical review of cases not limited to (including complex and challenging cases requiring expert judgement)), clinical trial, and literature cases including combination products {drug-device}) according to client/Parexel Standard Operating Procedures (SOPs
as applicable) and liaising with the client, as require
Writing Pharmacovigilance/Marketing Authorization Holder (MAH) comment and assessing company causality
Review appropriateness of medical content in narrative for medical coherence
Assessing seriousness, listedness / expectedness of reported events
Providing medical inputs to case processing team
Raising appropriate follow-up queries for relevant information from the reporter/HCP (Health Care Professional)
Review and verify appropriate selection of adverse events from source documents, assign appropriate Medical Dictionary for Regulatory Activities (MedDRA) code, review narrative

What we offer

Flexible approach to work that meets your personal needs
Work from home
Benefits vary by country
Investment in your professional and personal development

Adhd Specialist Independent Prescriber

The ADHD Specialist Independent Prescriber plays a critical role in delivering h...

Location

United Kingdom

Salary:

61000.00 GBP / Year

Psychiatry UK

Expiration Date

Until further notice

Requirements

Registered Nurses: First-level registered Mental Health nurse (RMN) or First-level registered nurse (Adult Nurse/Children’s Nurse/Learning Disabilities Nurse) (with one year post qualification Secondary Mental Health service experience or further Mental Health qualification)
Must have Independent & Supplementary Non-Medical Prescribing (V300) qualification with 1-year post-prescribing qualification experience
1-year post prescribing qualification experience in Specialist ADHD Service. (Specialist ADHD experience can include working within private and/or NHS Secondary mental health practice) or equivalent
ADHD experience must include managing ADHD patients with prescribing responsibilities, including medication initiation, titration, review, and long-term management
Pharmacists: Registered Pharmacist with Non-Medical Prescribing Qualification
One year post qualification secondary mental health service experience or further training or One year post prescribing qualification experience in Specialist ADHD service. (Specialist ADHD experience can include working within private and/or NHS practice) or equivalent
ADHD experience must include managing ADHD patients with prescribing responsibilities, including medication initiation, titration, review, and long-term management
Sound clinical experience in the initiation, titration, and management of ADHD in adults
Strong patient-centred approach, showing empathy, professionalism, and the ability to build rapport with patients and colleagues
Excellent communication and interpersonal skills

Job Responsibility

Provide safe, effective, and evidence-based prescribing for adult ADHD patients in line with NICE guidelines, Psychiatry UK clinical policies, and the Royal Pharmaceutical Society (RPS) Prescribing Framework
Manage a defined caseload of patients during the titration and ongoing treatment phases, ensuring timely review of treatment effectiveness, side effects, and adherence
Communicate with patients through Psychiatry UK’s secure portal, offering clear, supportive, and clinically appropriate responses to medication-related queries
Complete End of Titration Reviews (EOTRs) and conduct annual medication reviews in a timely and thorough manner, ensuring continuity and quality of care
Exercise independent or supplementary prescribing rights within scope of practice, recognising limitations and seeking clinical advice when necessary
Collaborate closely with Consultant Psychiatrists and the wider ADHD service team to ensure coordinated, patient-centred care
Undertake regular risk assessments and review safeguarding concerns, escalating appropriately in line with organisational policy
Maintain accurate, detailed, and confidential clinical records using Psychiatry UK’s digital systems in accordance with professional and legal standards
Participate in audits, quality improvement activities, and the review of prescribing practices to support clinical governance and service development
Engage in regular clinical supervision and team learning to maintain high standards of clinical decision-making

What we offer

Health Cash Plan and Wellbeing Hub subscription
Employee Assistance Programme
Annual Volunteering Day
Enhanced Sickness and Family Leave pay
Length of Service Bonus
Work from Home allowance
Pension options
£1,000 per annum - working from home allowance
£5,000 - joining bonus

Medical Appeals/Grievance Specialist II - Registered Nurse

Responsible for utilizing clinical acumen and managed care expertise related to ...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

1 year experience in clinical and health insurance or other healthcare related field
3 years experience in clinical and health insurance or other healthcare related field AND 1 year Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
5 years experience in clinical and health insurance or other healthcare related field AND 2 years Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
8 years experience in clinical and health insurance or other healthcare related field AND 3 years above satisfactory job performance in the managed care environment with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
Associate’s Degree in a healthcare field of study or Nursing Diploma
Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) or a compact state as a Registered Nurse (RN), a Physical Therapist (PT) or a Licensed Master Social Worker LMSW.
Intermediate PC proficiency
Intermediate skill using office equipment, including copiers, fax machines, scanner and telephones
Maintain confidentiality and privacy
Advanced clinical knowledge

Job Responsibility

Perform in-depth analysis, clinical review and resolution of provider appeals/inquiries, corrected claims and subscriber reconsiderations, member appeals, corrected claims and provider grievances for all lines of business
Identify, research, process, resolve and respond to customer inquiries primarily through written / verbal communication.
Respond to a diverse and high volume of health insurance appeal related correspondence on a daily basis.
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of appeal, grievance and reconsideration requests.
Maintain complete and accurate records per department policy.
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
Demonstrate ability to apply plan policies and procedures effectively.
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
Attend staff and interdepartmental meetings.
Participate in continuing education and current developments in the fields of medicine and managed care.

Fulltime

Manager, Clinical Operations, International

Cabaletta is seeking a Manager/Sr Manager, Clinical Operations, International. R...

Location

Germany; Switzerland

Salary:

Not provided

Cabaletta Bio Inc

Expiration Date

Until further notice

Requirements

Bachelor’s Degree or advanced degree in life sciences or related field
Minimum 4 years of clinical trial management experience including management of study resources, vendors, budgets, supplies, critical path activities, and risk management, within Biotech or pharmaceutical industry or equivalent by experience
Cell therapy experience preferred and/or focus complex therapies
Fluency in English
working proficiency in additional European languages a plus
Experience with early phase, complex trials
Experience managing Contract Research Organizations and other external vendors
Good understanding of European regulatory requirements (EMA, MHRA, etc)
Working knowledge of GCP/ ICH regulatory guidelines
Extensive knowledge of standard industry practices related to study start-up, site management and monitoring, document management, and clinical supply management

Job Responsibility

Provide day-to-day clinical project management oversight of the full range of clinical operations activities associated with clinical trial conduct from protocol development, feasibility/capability assessments, initiation, execution, control, and closure
Perform hands-on activities not outsourced to vendors, as needed
Author study documents and plans such as ICF and study specific plans
Provide input and review of site training materials
Review and provide clinical operations input into relevant clinical documents such as the protocol, investigator brochure, regulatory documents, clinical study reports and other documents and plans as appropriate
Proactively identify risks and lead team members to mitigate risks in a timely fashion
Develop and maintain positive relationships, both internal and external to project, including site personnel (KOLs, PIs, Study Coordinators)
Select and manage vendors
Perform and document study-level Sponsor Oversight of outsourced clinical activities
Execute clinical operations country submission tasks and documents: Review submission pack, coordinate country-specific ethics RFIs, review and update site-specific consent forms

What we offer

health and retirement
PTO
stock option plans

Oncology Early-Stage Clinical Scientist

You will lead and coordinate the development of multiple studies of novel biolog...

Location

United States , Cambridge; La Jolla; Bothell; Groton; New York City

Salary:

176600.00 - 282900.00 USD / Year

Pfizer

Expiration Date

Until further notice

Requirements

Relevant PhD or PharmD and a minimum of 5 years of experience in a similar role in industry/CRO
MS and a minimum of 7 years of experience in a similar role in industry/CRO
BA/BS and a minimum of 10 years of experience in a similar role in industry/CRO
Clinical Research experience in Phase 1 in Oncology, on the side of the sponsor leading studies
Experience in or strong understanding of Oncology Drug Development especially in Early Development
Strong knowledge of clinical procedures, ICH guidelines, GCP and familiarity with FDA, EMA, and global regulations
Strong scientific writing skills and communication skills (written and verbal)
Clinical document writing experience (e.g., protocol, ICD, IB, IND), as well as understanding complex data analysis
Track record of scientific productivity as evidenced by publications, posters, abstracts and/or presentations
Experience working with and solid understanding of related disciplines, e.g., Clinical Operations, Data Management, Safety, Biostatistics, Regulatory, Study Management, Pre-Clinical, Pharmacology, Quality Assurance

Job Responsibility

Partner closely with the Global Development Lead (GDL) in the execution of the clinical development strategy and plan for the assigned molecule(s)/indication(s)
Responsible for scientific leadership and execution of clinical studies and delivering on innovative clinical study designs, high quality trial execution, safety assessment and interpretation of clinical study results
Support execution for all FIH programs through proof-of concept
Set the clinical data review strategy, ensure quality data and conduct review of emerging clinical data and trends
review and query data
present and discusse relevant data to appropriate teams, governance bodies, and other internal and external stakeholders
Conduct data review, analysis and interpretation of clinical trials data together with the GDL, Clinical Safety, and Biostatistics
Serve as technical resource for clinical issues raised by internal and external collaborators, investigators, consultants and contractors
Support and assist in the development of publications, abstracts, and presentations
May sit on project teams to support clinical development implementation and contribution to key development milestones, e.g. start-up and delivery of ESoE and PoC trials

What we offer

Eligibility for participation in Pfizer’s Global Performance Plan with a bonus target of 20.0% of the base salary
Eligibility to participate in our share based long term incentive program
401(k) plan with Pfizer Matching Contributions and an additional Pfizer Retirement Savings Contribution
Paid vacation, holiday and personal days
Paid caregiver/parental and medical leave
Health benefits to include medical, prescription drug, dental and vision coverage
Relocation assistance may be available based on business needs and/or eligibility

Fulltime

DRG Clinical Dispute Reviewer

At Zelis, the DRG Clinical Dispute Reviewer role is responsible for the resoluti...

Location

United States , St. Petersburg; Plano; Boston; St. Louis; Atlanta

Salary:

95000.00 - 127000.00 USD / Year

Zelis

Expiration Date

Until further notice

Requirements

5+ years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims
Current, active Inpatient Coding Certification required (ie. CCS, CIC,RHIA, RHIT, CPC or equivalent credentialing)
Solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers
Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs
Understanding of hospital coding and billing rules
Clinical skills to evaluate appropriate Medical Record Coding
Experience performing regulatory research from multiple sources, formulating an opinion, and presenting findings in an organized, concise manner
Background and/or understanding of the healthcare industry
Knowledge of National Medicare and Medicaid regulations
Knowledge of payer reimbursement policies

Job Responsibility

Review provider disputes for DRG Coding and Clinical Validation (MS and APR)
Review and submit explanation of dispute rationale back to providers based on dispute findings within the designated timeframe to ensure client turnaround times are met
Accountable for daily management of claim dispute volume, adhering to client turnaround time, and department Standard Operating Procedures
Serve as subject matter expert for the Expert Claim Review Team on day-to-day activities including troubleshooting and review for data accuracy
Serve as a subject matter expert for content and bill reviews and provide support where needed for inquiries and research requests
Create and present education to Expert Claim Review Teams and other departments dispute findings
Research and analysis of content for DRG reviews
Use of strong coding and industry knowledge to create and maintain claim review content, including but not limited to DRG Reviewer Rationales, DRG Clinical Validation Policies and Dispute Rationales
Perform regulatory research from multiple sources to keep abreast of compliance enhancements and additional bill review opportunities
Support for client facing teams as needed relating to client inquiries related to provider disputes

What we offer

401k plan with employer match
flexible paid time off
holidays
parental leaves
life and disability insurance
health benefits including medical, dental, vision, and prescription drug coverage

Fulltime

Clinical Merchandising Manager

We’re looking for a Clinical Merchandising Manager to support category strategy,...

Location

Canada , Toronto

Salary:

124000.00 - 140000.00 CAD / Year

Fullscript

Expiration Date

Until further notice

Requirements

Advanced degree (MD, NP, RN, PA, MSc/PhD or equivalent) in a scientific or integrative healthcare field
Two to three years of experience as a Medical Science Liaison or a related role in the pharmaceutical, biotechnology, functional food or supplement industry is required
Strong ability to interpret and apply clinical research
Familiarity with supplement formulation, ingredient quality standards, and regulatory considerations
Strong written and verbal communication skills
Ability to collaborate cross-functionally and with external stakeholders

Job Responsibility

Monitor emerging clinical research, ingredient trends, and evolving standards of evidence to identify category and assortment implications
Contribute to ingredient- and condition-level category reviews, using clinical evidence and market insights to inform strategy, sourcing decisions, and practitioner engagement approaches
Support identification and sourcing of novel ingredients or brands through scientific literature, conferences, and industry events
Act as a clinical partner to industry partners and strategic vendors, translating evidence into compelling practitioner education and communication opportunities
Collaborate with internal and external partners to ideate and define the clinical narrative and educational storyline for partner initiatives
Review and validate clinical content—including guides, courses, and practitioner education materials—for scientific accuracy, compliance, and strategic alignment
Collaborate closely with the Education team to support operational planning, timelines, and workback schedules for educational initiatives
Serve as a cross-functional connector, aligning clinical, merchandising, and educational priorities
Lead the translation of clinical insights into practitioner- and patient-facing education materials and marketing messaging, ensuring accuracy, clarity, and engagement
Partner with Merchandising and Marketing to identify and elaborate clinically grounded marketing themes

What we offer

Competitive Total Rewards offerings
RRSP plan & matching (within Canada)
401(k) savings plan & matching (within US)
Customizable Health Benefits
Flexible Paid Time Off program
Discounts on Fullscript catalog of products for self, family & friends
Training allowance and company-wide learning initiatives
Work Wherever You Work Well

Fulltime

Initial Clinical Reviewer

Blue Cross Blue Shield of Arizona

Location:
United States , Phoenix

Category:
Health and Beauty

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
March 13, 2026

Looking for more opportunities? Search for other job offers that match your skills and interests.

Similar Jobs for Initial Clinical Reviewer

Client Partner for Clinical Review

Senior Physician, Patient Safety

Adhd Specialist Independent Prescriber

Medical Appeals/Grievance Specialist II - Registered Nurse

Manager, Clinical Operations, International

Oncology Early-Stage Clinical Scientist

DRG Clinical Dispute Reviewer

Clinical Merchandising Manager

Initial Clinical Reviewer

Blue Cross Blue Shield of Arizona

Location:United States , Phoenix

Category:Health and Beauty

Contract Type:Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:March 13, 2026

Looking for more opportunities? Search for other job offers that match your skills and interests.

Similar Jobs for Initial Clinical Reviewer

Client Partner for Clinical Review

Senior Physician, Patient Safety

Adhd Specialist Independent Prescriber

Medical Appeals/Grievance Specialist II - Registered Nurse

Manager, Clinical Operations, International

Oncology Early-Stage Clinical Scientist

DRG Clinical Dispute Reviewer

Clinical Merchandising Manager

Location:
United States , Phoenix

Category:
Health and Beauty

Contract Type:
Not provided

Job Posted:
March 13, 2026