Medical Peer Reviewer Job at Healthfirst

Physician Peer Reviewer

A vital role of the CMO Administration team, the Medical Peer Reviewer plays a c...

Location

United States

Salary:

122907.00 - 188020.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

Licensed M.D. or D.O. or D.M.D. or D.D.S.
Board Certified in a specialty recognized by the American Board of Medical Specialties
New York State Board Certified in Internal Medicine or Family Practice
Previous, relevant experience in utilization management and clinical practice
Knowledge of Medicare, Medicaid, and MLTC plans
Time management, critical thinking, communication, and problem-solving skills
Knowledge of UM//QM case philosophies and reporting requirements to state and federal agencies
Knowledge of member satisfaction//incident management and regulations
Knowledge of quality improvement methodologies
Ensures compliance to internal Healthfirst and external regulations

Job Responsibility

Assess//review requests for authorization, and claims payment, based on medical records and internal Healthfirst information and make informed clinical judgments and recommendations
Render determinations in the format and within timeframes to follow Regulatory and Operational policies
Maintain productivity standards
Collaborate with Utilization Management and Care Management and medical departments as needed, reviews and manages cases//caseload from multiple lines of businesses
Demonstrate the ability to be flexible when case load volume fluxes and when Leadership requests changes in case priorities to support our members//internal medical departments as needed
Complete mandatory Company compliance training and training in new systems and software
Enter each day’s hours worked in Workday, on the same day
Perform other duties as assigned

What we offer

medical, dental and vision coverage
incentive and recognition programs
life insurance
401k contributions
Paid Time Off (PTO)
Holiday pay

Parttime

Freelance Medical Writers (2 Positions)

Our client, a NYC-based pharmaceutical agency, is seeking experienced Freelance ...

Location

United States

Salary:

Not provided

Solomon Page

Expiration Date

Until further notice

Requirements

Strong background in pharmaceutical sciences, life sciences, or a related field
Prior experience in a medical communications or advertising agency environment preferred
Experience with scientific writing, referencing, and annotation of clinical content
Familiarity with Medical-Legal-Regulatory (MLR) review processes
Proven ability to interpret, review, and summarize peer-reviewed medical literature
Strong attention to detail with the ability to manage deadlines in a fast-paced environment

Job Responsibility

Develop, edit, and review high-quality medical and scientific content for pharmaceutical and healthcare communications
Annotate, cite, and reference scientific and clinical source materials accurately and consistently
Conduct literature reviews and synthesize findings from peer-reviewed medical journals
Support Medical-Legal-Regulatory (MLR) review processes, including addressing reviewer feedback and ensuring compliance
Collaborate closely with cross-functional teams including account, strategy, creative, and medical affairs
Ensure all deliverables meet scientific accuracy, regulatory requirements, and brand guidelines

What we offer

medical
dental
401(k)
commuter benefits

Fulltime

Medical Staff Administrative Assistant

A Healthcare Company is seeking a highly organized and detail-oriented Medical S...

Location

United States , Santa Monica

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Previous administrative assistant or high-level administrative support experience, preferably in a hospital or healthcare setting
Strong understanding of medical terminology required
Experience supporting committees, preparing documentation, and taking detailed meeting minutes
Ability to manage sensitive information with discretion and accuracy
Excellent organizational skills and strong attention to detail
Strong written and verbal communication skills
Familiarity with medical staff services, peer review processes, or physician credentialing is preferred
Credentialing experience is not required
Associate’s or Bachelor’s degree in healthcare administration, biology, or a related field is a plus

Job Responsibility

Provide administrative support to the medical staff office with a primary emphasis on peer review activities
Coordinate and organize peer review cases, including gathering, tracking, and documenting case-related information
Prepare materials for committee review and assist with follow-up on items requiring committee attention
Take accurate meeting minutes for peer review and other medical staff committee meetings
Maintain detailed, organized, and confidential documentation related to case reviews and hospital issues requiring committee evaluation
Assist in monitoring and supporting committee workflows to help ensure timely review processes
Work closely with internal teams and medical staff to support communication and documentation needs
Support medical staff operations related to physician credentialing and recredentialing, as needed
Handle sensitive and confidential information in accordance with hospital policies and professional standards

What we offer

Medical Insurance
Dental Insurance
Vision Insurance
401K Retirement
Sick Time Off
Tuition Reimbursement

Fulltime

Rn Quality Pediatric Cardiac Icu/transplant Specialist

The Data Quality Specialist is responsible for abstracting, analyzing and submit...

Location

United States , Hollywood

Salary:

Not provided

Memorial Healthcare System

Expiration Date

Until further notice

Requirements

Accredited Program: Nursing
Registered Nurse License (RN LICENSE) - State of Florida (FL)
Three (3) years of experience in areas of clinical focus
Florida licensure as a Registered Nurse or trained medical Physician

Job Responsibility

Serves as a resource person to the Medical Staff, Nursing and Ancillary Departments and performs validation audits/rounds and education as needed to assess regulatory/standard compliance as assigned
Effectively hosts and or participates in live or virtual meetings utilizing virtual meeting platforms on-site or from a remote location as needed and as assigned
Investigates incident reports, patient complaints, patient care issues
acts as a resource on quality issues and contributes to problem solving of identified quality/risk issues as assigned
Assists in the collection, coordination, formation, implementation, benchmarking and reporting of key performance indicators
Performs comprehensive, concurrent, and retrospective clinical reviews and abstractions as assigned
Works with the Chief Medical Officer and Medical Staff Department Chairpersons on Peer Review activities and prepares QI reports for Medical Department Meetings
Facilitates Medical Staff Peer Review and all activities related to Departmental and Multidisciplinary Peer Review as assigned
Utilizes and interprets information obtained from MHS Quality Improvement Technology Platforms as well as external quality data platforms to obtain quality data for benchmarking as assigned

Fulltime

Regulatory Data Analyst

The Regulatory Data Analyst plays a crucial role in delivering high-quality heal...

Location

United States , Charleston

Salary:

Not provided

MUSC Health

Expiration Date

Until further notice

Requirements

Required bachelor’s degree in healthcare administration, nursing, data analytics, public health, or related field
3 years of experience in healthcare quality improvement, regulatory compliance, medical staff services, or healthcare data analytics

Job Responsibility

Facilitation of Peer Review Processes
Coordinates Physician Peer Review and Professionalism process across clinical departments
Oversees cases submitted for peer review and assigns them to the appropriate specialty reviewers
Supports Professionalism and Peer Review Committees/sub-committees by preparing agendas, collecting data, documenting minutes, and following up on action items
Monitor completion of peer review cases and escalate delays
Analyze clinical performance data and compile practitioner performance profiles for department chairs and credentialing committees
Identify trends in professionalism and peer review outcomes that indicate practitioner performance issues, and system or process failures
Regulatory Compliance and Accreditation
Remain current with regulatory requirements and accreditation standards, i.e., CMS, DPH, and Joint Commission
Assist in preparing for regulatory inspections and accreditation surveys

Fulltime

Behavioral Health Medical Director

The Behavioral Health Medical Administrator (Medical Director) directs, leads, a...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

3 years of experience in a clinical setting
1 year of experience in physician leadership role, including quality review, utilization review, population health and other managed care functions
Medical Degree
Active, current, and unrestricted license to practice medicine in the State of Arizona (a state in the United States)
Board Certification in general psychiatry, or adult and child/adolescent psychiatry, through the American Board of Psychiatry and Neurology
Requires knowledge and skills in state (Arizona) and federal behavioral health regulations, requirements for publicly funded services, delivery, operations, and licensure.
Knowledge of managed care concepts and practices
and emerging and best practices for adult & children’s integrated care programs.
Ability to use electronic word processing, email, and electronic database resources.
Excellent customer service and oral/written communication skills

Job Responsibility

Directs, leads, and provides professional oversight for medical management and population health activities related to behavioral health utilization management, case and care management, disease management, performance improvement, and quality management activities.
Supports collaborative relationships with physicians and hospitals to achieve mutually acceptable business goals in compliance with AHCCCS and CMS regulations.
Provides physician leadership and medical oversight in the design, implementation and review of clinical services, best practices, care management, medical management and quality management.
Serves as liaison between the Medicaid Business Segment and medical and behavioral health practitioners at stakeholder and provider agencies.
Participates in aggregate and member-level clinical analyses for quality management, quality of care concerns, peer review, medical management, and utilization review processes.
Reviews and authorizes requests by providers and treatment coordinators for services or programs requiring prior authorization.
Participates in the design and implementation of best practices, clinical standards, protocols, and treatment guidelines.
Participates in credentialing, re-credentialing and competency processes for providers.
Assists care managers with care management of high risk/high-cost members.
Participates as a member or chair of internal and external committees.

Parttime

Ambulatory Clinical Pharmacist - Neurology

The Ambulatory Clinical Pharmacist provides comprehensive pharmaceutical care fo...

Location

United States , Kansas City

Salary:

Not provided

The University of Kansas Health System

Expiration Date

Until further notice

Requirements

Bachelors Degree in Pharmacy from an accredited college or university
Licensed Pharmacist - State Board of Pharmacy in state of primary practice site
Advanced Cardiac Life Support (ACLS) - American Heart Association (AHA) certification as necessary
Pediatric Advanced Life Support (PALS) and/or Neonatal Resuscitation Program (NRP) certification as necessary
Basic Cardiac Life Support (BLS or BCLS) - American Heart Association (AHA)

Job Responsibility

Actively participates in organizational and departmental performance improvement efforts to strengthen existing systems, processes, policies and procedures by introducing new ideas that lead to improved pharmaceutical care in clinical areas and in the pharmacy department as a whole
Actively participates on the multidisciplinary team by consistently attending patient care rounds and providing patient – focused pharmaceutical care by assessing and monitoring drug therapy to ensure safe and cost – conscious treatment regimens
Actively supports department staffing needs by flexing to other areas or alternative scheduling in order to assist in coverage of supplemental shifts when primary team is in need
Assures timely medication order processing by participating in order entry, order verification and reviewing medication orders for timely resolution of problem orders
Completes patient-specific medication profile reviews resulting in execution of protocol based drug therapy including, but not limited to pharmacokinetic dosing and IV to PO conversions with appropriate documentation. Adjusts doses as appropriate for patient specific parameters such as renal or hepatic dysfunction
Continually reports medication incidents and adverse drug reactions in Patient Safety Net (PSN) and participates in medication incident review, peer review, or other activities to establish safe medication systems
Participates in medication reconciliation at the time of admission, transfer, and/or discharge and provides patient education when appropriate
Shares pharmaceutical expertise by coordinating and providing educational presentations or in-services for pharmacy and non-pharmacy staff
Supports pharmacy residency programs, clerkship students and interns by precepting organized rotations, providing timely and constructive feedback, participating in training and orientation, providing mentorship, and collaborating on presentations and projects
Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department

Director, Medical Information

Beam is seeking a driven and scientifically rigorous Director of Medical Informa...

Location

United States , Cambridge

Salary:

210000.00 - 260000.00 USD / Year

Beam Therapeutics

Expiration Date

Until further notice

Requirements

Advanced scientific degree required: PharmD, MD, PhD, or equivalent in life sciences, pharmacy, or a related field
Minimum 7 years of experience in Medical Information, Medical Affairs, or Medical Communications within the pharmaceutical or biotechnology industry
Experience contributing to or building Medical Information capabilities, including SOP development and content library management
Solid working knowledge of medical review processes (MRC/PRC) and promotional/non-promotional content review, with familiarity with applicable FDA and EMA regulations
Strong scientific writing skills with experience developing SRDs, medical information responses, and clinical content for internal and external audiences
Ability to work effectively cross-functionally in a fast-paced, pre-commercial biotech environment with lean teams and evolving priorities
Interest in or exposure to rare disease therapeutic areas, including the scientific and operational challenges of small patient populations
Experience in cell and gene therapy, gene editing, or other advanced therapy medicinal products, preferred
Exposure to AI/ML applications in Medical Affairs or Medical Information, including prompt engineering, LLM evaluation, or AI governance, preferred
Familiarity with medical information platforms (e.g., Veeva Vault, Salesforce Health Cloud, MedAnswers) or emerging AI-powered MI solutions, preferred

Job Responsibility

Establish the Medical Information department from the ground up, including defining the operating model, staffing plan, technology infrastructure, and standard operating procedures (SOPs)
Develop and maintain the MI quality framework to ensure all scientific content meets regulatory, compliance, and scientific integrity standards
Serve as the internal subject matter expert on medical information best practices, regulatory expectations (FDA, EMA), and industry benchmarks for rare disease and advanced therapies
Build and oversee the medical review process for promotional and non-promotional materials, ensuring scientific accuracy and alignment with label and clinical data
Partner in the establishment of a Medical Review Committee (MRC) / Promotional Review Committee (PRC), collaborating closely with Regulatory Affairs, Legal, and Commercial teams
Create and maintain a comprehensive library of standard response documents (SRDs), custom responses, and medical FAQs covering the company's cell and gene therapy pipeline across rare disease indications
Author and review medical information letters, disease education materials, clinical summaries, and scientific dossiers for internal and external use
Ensure all MI content reflects the most current evidence base, including clinical trial data, real-world evidence, and peer-reviewed literature
Partner with Medical Science Liaisons (MSLs), Clinical Development, and Commercial teams to develop scientifically rigorous training materials, slide decks, and internal reference tools
Lead the development of pipeline and disease area resources that enable cross-functional teams to communicate accurately about the science of cell and gene therapies

Fulltime

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Medical Peer Reviewer

Job Description

Job Responsibility

Requirements

What we offer

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