- Humana (Nashville, TN)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, DME, skilled nursing facility and… more
- Amgen (Nashville, TN)
- …HUB, providing live one-on-one coverage support + Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer ... prior authorization to appeals/denials requirements and forms. + Review patient-specific information in cases where the site has...the products are covered under the benefit design (Commercial, Medicare , Medicaid). + Serve as a payer expert for… more
- Evolent (Nashville, TN)
- …is a key member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical Directors and interacts with ... well as health plan members and staff whenever a physician `s input is needed or required. Responsible for clinical...Manager. + Provides medical direction to the support services review process. Responsible for the quality of utilization … more
- Aveanna Healthcare (Franklin, TN)
- …as established by the plan of care, the interdisciplinary team, attending physician and Hospice Medical Director. Essential Job Functions: + Ensures the timely ... care as established by the hospice team and attending physician . + Assesses the total needs of the patient/family...+ Collaborates with the interdisciplinary team in the development, review and revision of the clinical component of patient/family… more
- Covenant Health Inc. (Knoxville, TN)
- …Covenant Medical Group (http://www.covenantmedicalgroup.org/) , our area's fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health ... CPT coding, modifiers and billing processes to ensure compliance with Medicare , Medicaid guidelines and other insurance payors and to maximize reimbursement.… more
- HCA Healthcare (Nashville, TN)
- …patient goals and maintain high quality patient care. Performs in accordance with physician 's orders and under the supervision of the Clinical Manager. **What you ... indicate continuing communication and coordination of services with the physician , other interdisciplinary team members and patient/family/caregiver. + Communicates… more
- Humana (Nashville, TN)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Covenant Health Inc. (Knoxville, TN)
- …Covenant Medical Group (http://www.covenantmedicalgroup.org/) , our area's fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health ... through for status placement. The UM Specialist collaborates with attending physician if ambiguous documentation pertaining to patient status placement requires… more
- Evolent (Nashville, TN)
- …interacts with leadership and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will Be Doing:** . Serve ... as the Physician match reviewer in Advanced Imaging cases, that do...rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Nashville, TN)
- …interacts with leadership and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will Be Doing:** + Serve ... as the Physician match reviewer in Imaging cases, that do not...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
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