- Bassett Healthcare (Sherburne, NY)
- … member goes into waiting area to greet patient as observed by supervisor and/or peer review , and rooms patient as soon as possible. + Patient is identified ... staff to adjust appointment schedules to Supervisor for review and approval before acting, as noted by Supervisor....National Patient Safety Goals as observed by supervisor and/or peer review + Documents with accuracy patient… more
- Evolent (Albany, NY)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... rationale for standard and expedited appeals. + Discusses determinations ( peer to peer phone calls) with requesting...(NCQA) guidelines. + Ensures documentation of all communications with medical office staff and/or MD provider is… more
- Evolent (Albany, NY)
- …+ Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting...Clinical Reviewers. + Ensures documentation of all communications with medical office staff and/or MD provider is… more
- Evolent (Albany, NY)
- …and provides clinical rationale for standard and expedited appeals. . Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... completed by the subject matter expert. . Discusses determinations ( peer to peer phone calls) with requesting...Clinical Reviewers. . Ensures documentation of all communications with medical office staff and/or MD provider is… more
- Evolent (Albany, NY)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting...expedited appeals. + Ensures documentation of all communications with medical office staff and/or MD provider is… more
- Evolent (Albany, NY)
- …and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting...Clinical Reviewers. + Ensures documentation of all communications with medical office staff and/or MD provider is… more
- Mount Sinai Health System (New York, NY)
- …determination is established),_ follows up at regular interval to ensure payer response. Coordinate peer to peers _(ie If case is denied, ensure timely peer to ... certification and denial data into tracking system based on review of payer communication. Enter in end of day...for billing purposes. Contact insurance companies and set up peer to peer telephone conference. Communication sent… more
- Mohawk Valley Health System (Utica, NY)
- …of care advisement. + Support education to minimize clinical variability throughout the medical staff . + Assist case managers with Medicare and Medicaid appeals ... reimbursement models in decision making and reviews. + Provide peer -to- peer payor review in collaboration...liaison between the CDI professional, HIM, and the hospital's medical staff to facilitate accurate and complete… more
- Elevance Health (New York, NY)
- …development. The ** Medical Director, Cardiology** is responsible for supporting the medical management staff ensuring timely and consistent medical ... medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review or policy… more
- Bassett Healthcare (Cobleskill, NY)
- …accredited by The Joint Commission. CRH provides inpatient care for general medical conditions, an inpatient short-term rehabilitation unit, and more than 20 ... than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation and co-worker feedback. +...of the time, as observed by supervisor and POC staff . + (RN I only) Maintains and documents testing… more