and communities. To learn more about who we are at Point32Health, click . Job Summary The Medical Director, Clinical reviews..., concurrent, and retrospective utilization reviews including both member-facing initial reviews and appeals. They will work...
) Independent Medical Exam(s) (IME) RN Coordinator RN Case Manager Legal Assistant Paralegal Clinical Reviewer... management relative to one or more of the following categories: utilization management, coding, claims review, clinical appeals...
license. If feasible, be in active clinical practice in the area in which the Resource is board certified at least sixteen (16... reviewer for the Department of Human Services, Office of Medical Assistance Programs (Department). Consultant will: 1...
, medical necessity, and efficient utilization of health care services. The PA conducts clinical reviews on cases in accordance... with the hospital’s objectives for assuring quality patient care and effective clinical documentation. Responsibilities: The...
for regulatory compliance, medical necessity, and efficient utilization of health care services. The PA conducts clinical reviews... on cases in accordance with the hospital’s objectives for assuring quality patient care and effective clinical documentation...
regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals. Utilizes medical.... We can offer you a meaningful way to make a difference in patients’ lives, in a non-clinical environment. You can enjoy...
timeframe of the request and provides clinical rationale for standard and expedited appeals. Utilizes medical/clinical review.... We can offer you a meaningful way to make a difference in patients’ lives, in a non-clinical environment. You can enjoy...
effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring... and/or additional information when necessary. Consult with staff clinical pharmacist for guidance and assistance as necessary...
and procedures in conjunction with associate medical directors and other clinical staff and assures consistency and compliance... with generally accepted medical standards and guidelines. Provides clinical support for all areas of Clinical Services. Review...
. Stay for the culture. What You’ll Be Doing: Job Description As a Physician Clinical Reviewer, you will be a key... regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals. Utilizes medical...
regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals. Utilizes medical... management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can...
appeals and applicable clinical records to physician advisors; and analyzes high medical cost claimants and prepares..., wellness/disease management, product development efforts. Prepares and presents thorough clinical record reviews to first...
reviews medical record for clinical denials. Composes a detailed summary of care and sends appeals to MCO, Medicare, or RAC... of denial activity and appeal results. Maintains the Status Change Database. Performs retrospective clinical reviews/appeals...
. Provides clinical rational for standard and expedited appeals. Participate in peer-to-peer review with payors and/or complete... appeals as required to overturn denials. Provides assistance to initial clinical reviewers as needed to discuss cases...
regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals. Utilizes medical...-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning...
reviews to be completed by the subject matter expert. Provides clinical rationale for standard and expedited appeals... utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical...
or DO reviewer. -Must be in active medical practice to perform appeals JOB-RELATED EXPERIENCE: Post-graduate experience in direct.... JOB SUMMARY: Relying on clinical background, reviews health claims providing medical interpretation and decisions about the...
of Osteopathic Specialties is required for MD or DO reviewer. -Must be in active medical practice to perform appeals JOB-RELATED... schedule and be compensated on a per case basis as a 1099 independent contractor. JOB SUMMARY: Relying on clinical...
or DO reviewer. -Must be in active medical practice to perform appeals JOB-RELATED EXPERIENCE: Post-graduate experience in direct.... JOB SUMMARY: Relying on clinical background, reviews health claims providing medical interpretation and decisions about the...
or DO reviewer. -Must be in active medical practice to perform appeals JOB-RELATED EXPERIENCE: Post-graduate experience in direct.... JOB SUMMARY: Relying on clinical background, reviews health claims providing medical interpretation and decisions about the...