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...
Job Description: 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...
Job Description: 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...
physician reviewer for all cases referred by the Quality Improvement and Care Management Departments. Daily activities support... in the daily utilization management and quality improvement review processes, including concurrent, prospective...
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...
not meeting clinical criteria to pharmacist clinical reviewer. Practices and maintains the principles of utilization management... company achieving revenue goals and operational objectives. Responsible for executing utilization management programs...
. More about our team Accountable for the execution, adaptation and outcome of care management as prescribed in the initial Utilization... appropriate level-of-care placement. • Uses EMR and MCG Criteria for utilization management and quality screening. • Identifies...
for reviewing and processing coverage determinations and utilization management reviews for specialty medications, to include site... in utilization management reviews. The Pre-Certification Review Nurse – Pharmacy will work and collaborate with a multi-disciplinary...
for reviewing and processing coverage determinations and utilization management reviews for specialty medications, to include site... in utilization management reviews. The Pre-Certification Review Nurse - Pharmacy will work and collaborate with a multi-disciplinary...
role The Behavioral Health Utilization Management Clinician provides utilization management for all behavioral health...; within the designated time frames indicated. The Behavioral Health Utilization Management Clinician also partners with providers...
role The Behavioral Health Utilization Management Clinician provides utilization management for all behavioral health...; within the designated time frames indicated. The Behavioral Health Utilization Management Clinician also partners with providers...
. More about our team Accountable for the execution, adaptation and outcome of care management as prescribed in the initial Utilization... appropriate level-of-care placement. • Uses EMR and MCG Criteria for utilization management and quality screening. • Identifies...
in Oncology. Requirements: As Physician Reviewer/Advisor, you will utilize clinical expertise and reviews insurance appeals..., and prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the medical necessity of services...
As Physician Reviewer/Advisor, you will utilize 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...
Job Description: 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...
in Radiology. Requirements: As Physician Reviewer/Advisor, you will utilize clinical expertise and reviews insurance appeals..., and prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the medical necessity of services...
. Requirements As Physician Reviewer/Advisor, you will utilize 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...
. ·Refers cases to Physician Reviewer when the treatment request does not meet medical necessity per guidelines, or when... guidelines are not available. ·Referrals must be made in a timely manner, allowing the Physician Reviewer time to make...
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...
Job Description: 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...