Medical Reviewer Case Processing Job at Cencora (Noida)

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

Medical Reviewer

The Medical Reviewer (MR) is responsible for providing medical review for indivi...

Location

India , Gurgaon

Salary:

Not provided

Baxter

Expiration Date

Until further notice

Requirements

Provide medical review for individual case safety reports, including: coding, seriousness, expectedness, Baxter causality assessment
Ensure that appropriate medical interpretation and consistency are applied to adverse event case assessment
Potential review of periodic documents, and product labels
Provide medical and scientific expertise on pharmacovigilance matters affecting the preparation and submission of timely and accurate information to the regulatory authorities
Support the Safety Operations team, providing expertise for the case processing team for medical questions e.g., coding of events, understanding coding conventions, splitting of cases etc.
Maintain knowledge of global regulatory authority regulations (especially FDA and EMA)
Contribute to the training, leadership and continuing education for all departmental staff
May perform benefit-risk safety analysis, including: safety surveillance activities for potential safety signals, aggregate safety data review, risk management plans and REMS, Regulatory Authority assessment reports and queries, and periodic documents, such as PSURs, PBRERs, and PADERs

Job Responsibility

Provide medical review for individual case safety reports, including: coding, seriousness, expectedness, Baxter causality assessment
Ensure that appropriate medical interpretation and consistency are applied to adverse event case assessment
Potential review of periodic documents, and product labels
Provide medical and scientific expertise on pharmacovigilance matters affecting the preparation and submission of timely and accurate information to the regulatory authorities
Support the Safety Operations team, providing expertise for the case processing team for medical questions e.g., coding of events, understanding coding conventions, splitting of cases etc.
Maintain knowledge of global regulatory authority regulations (especially FDA and EMA)
Contribute to the training, leadership and continuing education for all departmental staff
May perform benefit-risk safety analysis, including: safety surveillance activities for potential safety signals, aggregate safety data review, risk management plans and REMS, Regulatory Authority assessment reports and queries, and periodic documents, such as PSURs, PBRERs, and PADERs

Medical Reviewer

The Medical Reviewer (MR) is responsible for providing medical review for indivi...

Location

India , Gurgaon

Salary:

Not provided

Baxter

Expiration Date

Until further notice

Requirements

Provide medical review for individual case safety reports, including: coding, seriousness, expectedness, Baxter causality assessment
Ensure that appropriate medical interpretation and consistency are applied to adverse event case assessment
Provide medical and scientific expertise on pharmacovigilance matters affecting the preparation and submission of timely and accurate information to the regulatory authorities
Support the Safety Operations team, providing expertise for the case processing team for medical questions e.g., coding of events, understanding coding conventions, splitting of cases etc
Maintain knowledge of global regulatory authority regulations (especially FDA and EMA)
Contribute to the training, leadership and continuing education for all departmental staff
May perform benefit-risk safety analysis, including: safety surveillance activities for potential safety signals, aggregate safety data review, risk management plans and REMS, Regulatory Authority assessment reports and queries, and periodic documents, such as PSURs, PBRERs, and PADERs

Job Responsibility

Provide medical review for individual case safety reports, including: coding, seriousness, expectedness, Baxter causality assessment
Ensure that appropriate medical interpretation and consistency are applied to adverse event case assessment
Potential review of periodic documents, and product labels

Senior Director, Drug Safety Operations

The Senior Director, Drug Safety Operations will be provide leadership and direc...

Location

United States , San Diego

Salary:

280000.00 - 300000.00 USD / Year

Arrowhead Pharmaceuticals, Inc

Expiration Date

Until further notice

Requirements

12+ years of experience in Drug Safety/Pharmacovigilance Operations
Bachelor of Science with an advanced degree in pharmacy, nursing or related healthcare field
Strong working knowledge of case management and processing
Experience in using ARGUS or other safety databases
Experience with MedDRA/WHO for coding AEs, medical history, and concomitant medications
Experience with preparation with aggregate reports, preferably for investigational drugs (i.e., DSURs, IND Annual reports) or post-marketing products (i.e., PSUR/PBRER, PADERs)
Working experience with Safety Databases (Argus, ArisG or other) is required
Knowledge of ICH E2B guidelines in clinical and post-marketing studies
Good leadership and organizational skills with the ability to perform multiple tasks efficiently and effectively

Job Responsibility

Lead Case Processing and support safety medical review, generate appropriate queries to contact drug safety vendors (CROs) to complete and clarify SAE case information as needed and work with CRO to determine when cases are complete and ready to close
Ensure corporate compliance with domestic and international adverse event reporting requirements for all products in worldwide development programs
Ensure consistency in investigator causality assessment of SAE reports and source documentation for completeness, accuracy and legibility
Participate in the standardized set-up of new safety projects, including development of Safety plans and documents, and set-up of safety systems
Prepare, support and track PVAs/SDEAs with partners
Monitor compliance with partner Safety related activities needed as per PVA/SDEA
Create and maintain Safety Management Plans and Reporting documents in collaboration with vendors
Review vendor scope and assist with study level budgets as needed
Oversee submission activities for ICSRs and aggregate reports
Collaborate with vendors for TMF Safety documents filing and review

What we offer

competitive salaries and an excellent benefit package

Fulltime

New

Clinical Reviewer Specialist

The Clinical Reviewer Specialist role involves performing clinical reviews to re...

Location

Philippines , Manila

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

1-3 years of experience in processing appeals or utilization management
RN - Registered Nurse - State required Licensure and/or Compact State Licensure
Knowledge of utilization management process
Knowledge of NCQA, Medicaid regulations
Good communication (Demonstrate strong reading comprehension and writing skills)
Able to work independently, strong analytic skills
Required shift timings - US daytime

Job Responsibility

Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal
Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards
Communicates with providers, facilities and other departments regarding appeal requests
Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal and NCQA standards
Works with leadership to increase the consistency, efficiency, and appropriateness of responses of all appeal requests
Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices
Uses sound judgement, especially in non-routine appeals, to make decisions to keep the appeal process moving forward in accordance with contractual timeliness standards
Maintain files on individual appeals by gathering, analyzing and reporting verbal and written member and provider appeals
Review claim appeal for reconsideration and recommend approvals/denials based on determination level or prepare for medical review presentation
Prepare case recommendations for medical review as necessary

Fulltime

Behavioral Health Medical Director

The Behavioral Health (BH) Medical Director leverages clinical expertise to prov...

Location

United States

Salary:

189600.00 - 237000.00 USD / Year

Personify Health

Expiration Date

Until further notice

Requirements

MD or DO degree and 5+ years of direct clinical patient care experience post residency or fellowship including behavioral health environments
Current and ongoing Board Certification in psychiatry by the American Board of Psychiatry and Neurology (ABPN) required
Additional Board Certification in Child and Adolescent Psychiatry or Addiction Medicine
A current and unrestricted license in the state of California and willing to obtain additional license(s)
No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements
Minimum 5 years of Utilization Review or Hospital experience required
Minimum 3 years of compliance related experience preferred
Managed Care experience preferred in utilization review and case management
Expertise in behavioral health case management, utilization review and telehealth delivery
Ability to design and evaluate behavioral health programs, integrating evidence-based practices and holistic wellbeing approaches

Job Responsibility

Oversee and participate in behavioral health case management, including utilization review, telephonic care, and urgent response coordination for behavioral health and substance use disorder needs
Conduct reviews for medical necessity for prior authorization, continued stay, and post-service claims, applying medical policy, guidelines, and current research
Integrate behavioral health screening and interventions within physical health case management programs, utilizing standardized tools (e.g., PHQ2, PHQ9) and ensuring appropriate referrals
Support and monitor virtual behavioral health services, ensuring access, privacy, and continuity of care for all age groups, including children, teens, and adults
Supervise and provide clinical oversight for residential and outpatient behavioral health programs, including partial hospitalization and intensive outpatient services, with an emphasis on family engagement and comprehensive discharge planning
Lead the development and implementation of comprehensive behavioral health strategies, including program design, staff education, and quality improvement initiatives
Maintain compliance with national guidelines (e.g., MCG, InterQual, specialty college recommendations) and regulatory requirements (federal, state, ERISA) specific to behavioral health
Oversee the negotiation and implementation of cost management strategies to affect quality outcomes, reflecting data in monthly case management reviews
Participate in grievance and appeals processes, including escalated behavioral health issues
Collaborate with the VP of Care Management to establish work procedures and processes that support company and departmental standards, procedures, and strategic directives

What we offer

Comprehensive medical and dental coverage through our own health solutions
Mental health support and wellness programs designed by experts who get it
Flexible work arrangements that fit your life
Retirement planning support to help you build real wealth for the future
Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection
Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage
Professional development opportunities and clear career progression paths
Mentorship from industry leaders who want to see you succeed
Learning budget to invest in skills that matter to your future
Unlimited PTO policy

Parttime

New

Safety Surveillance Associate

You will be relied on by the company to monitor its drug, biologics and medical ...

Location

Philippines , Makati City

Salary:

Not provided

Pfizer

Expiration Date

Until further notice

Requirements

Bachelor's degree in a science-related field, pharmacy, nursing, or equivalent
healthcare Professional qualification required
Experience in pharmacovigilance, in clinical care, or in clinical or scientific research is an advantage but not a requirement
Demonstrated computer literacy, particularly in the use and management of relational databases
Ability to achieve personal objectives while meeting departmental standards of performance
Ability to work under supervision in a matrix organization
Excellent oral and written communication skills
Fluency in spoken and written English
knowledge of additional language(s) an advantage
Experience and skill with medical writing an advantage

Job Responsibility

Identify and select routine cases for processing, determining appropriate prioritization criteria, and noting reasons for any delays
Assess cases to distinguish those with particular complexities and/or specific issues, and escalate appropriately
Review, rank, verify, process and document: event terms
case classifications (validity, seriousness, expectedness/listedness/labeledness)
special scenarios
product complaint information
reportability with due date
and accuracy and consistency
Based on assessment of cases, process accordingly
Review case criteria to determine the appropriate workflow for case processing

Fulltime

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

Medical Reviewer Case Processing

Cencora

Location:
India , Noida

Category:
Research and Development

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
February 20, 2026

Expiration:
February 27, 2026

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Medical Reviewer Case Processing

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Location:India , Noida

Category:Research and Development

Contract Type:Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:February 20, 2026

Expiration:February 27, 2026

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Location:
India , Noida

Category:
Research and Development

Contract Type:
Not provided

Job Posted:
February 20, 2026

Expiration:
February 27, 2026