Determinations Determine that the case is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial... federal/state requirements and mandates (e.g., turnaround times, medical necessity) CPS_Review Existing Clinical...
Determinations Determine that the case is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial... federal/state requirements and mandates (e.g., turnaround times, medical necessity) CPS_Review Existing Clinical...
are responsible for Women's Health/ Gender Dysphoria/ Genetics clinical reviews and require a current, unrestricted RN nursing license... in the applicable state. Individual is responsible for performing pre-service clinical coverage review of outpatient Women...
require a current, unrestricted nursing license (i.e. RN) in the applicable state, as indicated in the function... description and/or job title. Positions in this function require various nurse licensure and certification based on role and grade level...
is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial) -Validate that cases/requests for services..., medical necessity) CPS_Review Existing Clinical Documentation Review/interpret clinical/medical records submitted...