. Requirements As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and reviews... insurance appeals, and prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the...
Company Overview: Acentra Health exists to empower better health outcomes through technology, services, and clinical... services appeals. Review records, prepare and submit all reviews in keeping with the TennCare/Acentra Health contractual due...
provides organizational leadership in the operational areas of care management, utilization review, appeals, quality.... Overseeing the quality of clinical care for network and non-network providers. Engaging the provider network in Continuous...
requests for assistance cases, grievances and appeals, per departmental guidelines. Coordinates members' health care and social... requests for assistance cases, grievances and appeals, per departmental guidelines. - Coordinates members' health care...
, email, and crowdfunding appeals for all Athletics constituents. The Associate Director will collaborate with development colleagues in the... will include direct mail, email, and crowdfunding appeals for all Athletics constituents. Key responsibilities: Annual Fund...
, and members as needed. Utilizes clinical knowledge and experience to support value-based strategies, clinical operations...'s knowledge and clinical skills will vary across the Health Care division, dependent on focus areas identified by the business...
, families, physicians, clinical staff, and insurance companies to obtain information and insurance verification to ensure... quality patient care and payment of hospital accounts. Collaborates with Appeals department to overturn claims denial...
quality clinical and radiographic evaluations to diagnose and treat diseases of the oral cavity Promote oral health... to Operations, HR and Clinical leaders Assist in the training of new hygienists and dental assistants Provide input...
is responsible for providing administrative and clerical support to the clinical nursing staff. About Us: Ecumen Lakeshore-The... more at Essential Job Responsibilities: * Responsible for obtaining clinical and therapy records to provide admission, concurrent...
with care management teams to optimize outcomes. Collaborates effectively with clinical teams, network providers, appeals...You could be the one who changes everything for our 28 million members as a clinical professional on our Medical...
), you will utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer...
operational areas of care management, utilization review, appeals, quality improvement and related policy and practice initiatives... guidelines throughout the provider network Monitors the quality of clinical care provided by in network and non-network...
, AZ. Requirements: As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and reviews... insurance appeals, and prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the...
patient encounter utilizing multiple system applications: various registration applications, clinical operating systems... are to start cases over the phone, follow up, provide, and fax any clinical notes pertaining to the case to the insurance payors...
provides organizational leadership in care management, utilization review, appeals, quality improvement, and related policy... of clinical care for network and non-network providers. Engaging the provider network in Continuous Quality Improvement through...
for Independent Medical Exams (IME), you will utilize clinical expertise and reviews insurance appeals, and prospective...
focusing their attention on the front line while partnering with our clinical team to drive the best possible outcomes... for every member. What you'll do (Essential Responsibilities) · Serves as a key clinical resource for staff. Establishes...
) review, escalating payment variance trends or issues to NIC management, and generating appeals for denied or underpaid claims... coding in DCM is accurate and reflects the denial reasons. Coordinate with the Clinical Resource Center (CRC) for clinical...
, and other clinical needs. Identify, de-escalate, and solve patient concerns as they arise Work with Quality and Compliance to ensure... or audits (CARF, OBHL, RHBA, state, DEA, fire, and alarm). Work alongside assigned Clinical Coordinator to assist...
Care Job Description: Clinical Operations Associate Medical Director Carelon Medical Benefits Management Location... and promoting the advancement of care for the people we serve. The Clinical Operations Associate Medical Director is responsible...