, researching, investigating, negotiating, and resolving all types of appeals and grievances. Communicates with appropriate parties... regarding appeals and issues, implications, and decisions. Analyzes and identifies trends for all appeals. May research...
in our mission Reviews provider appeals and redeterminations using approved clinical and coding guidelines and documents appeal... balance, continuous learning, and career development. Summary We are seeking a talented individual for a Nurse Reviewer...
in our mission Reviews provider appeals and redeterminations using approved clinical and coding guidelines and documents appeal... balance, continuous learning, and career development. Summary We are seeking a talented individual for a Nurse Reviewer...
in utilization review/appeals background Benefits of the Registered Nurse Clinical Reviewer: The salary for this position is $60...Job Description: JOB TITLE (#25154 B): Registered Nurse Clinical Reviewer / IDR - Lake Success, NY Minimum of 1-3...
in utilization review/appeals background Greenlife Healthcare Staffing is currently seeking a Registered Nurse Clinical Reviewer.../appeals background Benefits of the Registered Nurse Clinical Reviewer: The salary for this position is $60 / hr (based...
. Stay for the culture. What You’ll Be Doing: As a Physician Clinical Reviewer you will be a key member of the... regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals. Utilizes medical...
. Stay for the culture. What You’ll Be Doing: As a Physician Clinical Reviewer you will be a key member of the... regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals. Utilizes medical...
, and reviews insurance appeals, prospective and retrospective claims. The physician reviewer will provide an interpretation of the.... Specialty: Clinical/Medical Geneticist Must have active North Carolina license JOB SUMMARY Utilizes clinical expertise...
insurance appeals, prospective and retrospective claims. The physician reviewer will provide an interpretation of the medical...: Clinical/Medical Geneticist Must have active North Carolina license JOB SUMMARY Utilizes clinical expertise, and reviews...
JOB TITLE (#25188): Registered Nurse / Clinical Reviewer / Remote - New York State Minimum 1-3 years of experience... Clinical Reviewer to fill an opening with a Non-profit organization located in New York Requirements of the Registered Nurse...
utilization review/appeals background Benefits of the Registered Nurse Clinical Reviewer: The salary for this position is $55...JOB TITLE (#25154): Registered Nurse Clinical Reviewer / IDR - Lake Success or Albany, NY Minimum of 3 years...
Performs peer review and case management activities. Delivers clinical expertise to the organization through peer... and customers in making medical appropriateness and medical necessity decisions based on clinical protocols, scientific evidence...
Performs peer review and case management activities. Delivers clinical expertise to the organization through peer... and customers in making medical appropriateness and medical necessity decisions based on clinical protocols, scientific evidence...
Performs peer review and case management activities. Delivers clinical expertise to the organization through peer... and customers in making medical appropriateness and medical necessity decisions based on clinical protocols, scientific evidence...
Reviewer - LPN Grade 207 This is a full time position, Monday - Friday, working from home. The minimum and maximum annual... and appeals for LTSS services. POSITION HAS DIRECT REPORTS: No ESSENTIAL JOB DUTIES/FUNCTIONS % of Time Essential Function...
Reviewer - LPN Grade 207 This is a full time position, Monday - Friday, working from home. The minimum and maximum annual... and appeals for LTSS services. POSITION HAS DIRECT REPORTS: No ESSENTIAL JOB DUTIES/FUNCTIONS % of Time Essential Function...
Summary: The UM Reviewer serves as a contact and resource person to Health Solutions’ members for the utilization... review (UR) of healthcare services. The UM Reviewer will be responsible for complying with utilization review procedures...
, and clinical guidelines within scope of license. Conducts pre-certification, concurrent review, and appeals of Behavioral Health...Anticipated End Date: 2024-12-31 Position Title: Psychologist Reviewer Sr - North Carolina...
) JOB SUMMARY Utilizes clinical expertise, and reviews insurance appeals, and prospective and retrospective claims. The physician... reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals...
, Psychiatry, Rheumatology, Pediatrics, Ophthalmology. JOB SUMMARY Utilizes clinical expertise, reviews insurance appeals..., and prospective and retrospective claims. The physician reviewer will provide an interpretation of the medical necessity of services...