independent, remote case reviews evaluating medical necessity, appropriateness, or quality of care. Provide evidence-based... record review and accompanying report. Most cases take 1-3 hours to complete; shorter reviews may take less than 1 hour...
be required to represent the company to external entities and/or serve on external committees, conduct peer clinical and/or appeal case reviews... and peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations...
and peer support, spiritual care and stress management resources Family support: parental leave, adoption assistance... (PACE) and state agencies. Responsibilities: Submit annual state mandated Medicaid eligibility renewal packets...
-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients’ office...Anticipated End Date: 2026-02-06 Position Title: Utilization Management Medical Director – Indiana Medicaid...
a compelling story to stakeholders to enable and influence decision making; participating in peer reviews; and providing context...
reviews and facilitate peer review process among assigned staff members. -- Utilizes data to implement individual and program...
following: Applied Behavior Analysis service requests for both Commercial and Medicaid Plans The Peer Reviewer... Clinical Consultant, Peer Reviewer for ABA Services involves applying clinical and benefit plan criteria to service requests...
following: Applied Behavior Analysis service requests for both Commercial and Medicaid Plans The Peer Reviewer... Clinical Consultant, Peer Reviewer for ABA Services involves applying clinical and benefit plan criteria to service requests...
and billing oversight for Adult, Youth, and Family Peer Support Specialists in accordance with Kentucky Medicaid, CHFS, DBHDID.... Must meet all Kentucky Medicaid supervision requirements to provide billing oversight and clinical supervision for peer support...
599 standards. Operations, Quality, and Compliance Ensure compliance with OMH and Medicaid requirements for Peer... requirements and Medicaid billing practices Experience supervising peer roles (NYCPS, FPA-C, YPA-C) and integrating peer services...
. bloodborne pathogen exposures). KEY RESPONSIBILITIES: Admissions: Conduct admission reviews/Pre-Authorizations in a timely... manner. Concurrent Stay Reviews: Conduct concurrent and extended stay reviews for both managed care cases and Kepro counites...
quality and cost effective health care services. Some of your daily activities will include: Reviews planned, in process..., concurrent and retrospective review. Frequently collaborates and communicates with physician peer reviewers and medical...
quality and cost effective health care services. Some of your daily activities will include: Reviews planned, in process..., concurrent and retrospective review. Frequently collaborates and communicates with physician peer reviewers and medical...
Initiate pre-certifications for admissions and transfers. Perform concurrent reviews with commercial, Medicaid, Medicare... activities, concurrent reviews, precertifications, and discharge-related authorization functions to support timely reimbursement...
. Prescribe medication and monitor compliance, writes standing orders, reviews lab results, and takes appropriate action, counsels... frames and standards of care. Signs off on client treatment plans for Medicaid/Medicare. Record client's care in the...
/multiple family homes, presence of pets, etc.) using approved transportation options. Upon request, performs peer reviews... and any associated workgroups related to development of evidence based clinical models of care, peer education and training, quality...
/admissions promptly and accurately, including accurately adding insurance, accident information and account notes, reviews..., and documents account accordingly 4.Screens patients to determine eligibility for Medicaid and refers accounts to Medicaid Area 5...
overseeing requests for authorizations supporting medical necessity/service eligibility (Medicaid) and ensuring authorization..., QMHP, Peer Partner, and QMHA direct service staff documentation into Create and maintain employee records in CareLogic...
entry integrity Take lead responsibilities, along with CQI Manager, to develop, train, and implement Medicaid... and healthcare coding compliance strategies to ensure staff documentation is in compliance with Medicaid laws and regulations...
Manager and Supervisors to regularly schedule peer reviews and other CQI training courses. Support staff in participating..., and implement Medicaid and healthcare coding compliance strategies to ensure staff documentation is in compliance with Medicaid laws...