- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …development specialist to develop standard work and expectations for the utilization review process, including timely medical necessity screening to ensure ... payers, as appropriate * May participate in the Utilization Review Committee to present medical necessity data...interact with a wide variety of individuals, and handle complex and confidential situations * Ability to lead, delegate,… more
- UNC Health Care (Kinston, NC)
- …in order to establish appeals plan based on the type of denial. 7. Conducts case studies for those complex denials in order to plan appeal strategies and ... for all audit and appeals work activities. Assists with documentation review to support the clinical documentation specialists and Patient Financial Services.… more
- City of New York (New York, NY)
- …and ongoing monitoring of program data. - Review and advise on complex cases and lead/participate in case conferences for cases involving complex ... the health and outcomes of adults and families with complex medical and behavioral health conditions residing...incidents data to identify clients in need; using DHS case management data, oversee and create analytical programs to… more
- WellSense (MA)
- …all appropriate internal departments to resolve complex issues related to the medical and social case management needs of members. + In collaboration with ... no matter their circumstances. **Job Summary:** The Manager of Care Management-Pediatric Complex Care is responsible for the daily operations of the Special Kids… more
- Veterans Affairs, Veterans Health Administration (Daytona Beach, FL)
- …model and intensive case management to a panel of patients with complex chronic medical conditions managed under PCMM guidelines to reduce recurrent ED ... may be offered to highly qualified candidate(s). The incumbent will serve as a Complex t Patient Aligned Care Team (PACT) Physician located at the Daytona Beach VA… more
- Sedgwick (Jacksonville, FL)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Bill Review Analyst | Professional Liability | Remote **PRIMARY PURPOSE** : The Bill ... Review Analyst plays a critical role in supporting the medical malpractice claims team by ensuring legal invoice accuracy, compliance, and defensibility. This… more
- J&J Family of Companies (Raritan, NJ)
- …Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less ... searching for the best talent for an **Associate Director, Medical Writing & Literature Services** . _Remote work options.... _Remote work options may be considered on a case -by- case basis and if approved by the… more
- Amazon (Nashville, TN)
- …(DSP) and Last Mile organization. We provide these programs with operational, case management, and investigation support. Partners include but are not limited to: ... role, the primary function will be as a Quality Review Specialist. As an Individual Contributor, the Quality ...Key job responsibilities - Completes quality reviews for various complex work streams. - Adheres to Standard Operating Procedures… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …co-occurring psychiatric and substance abuse conditions. POSITION TITLE: Utilization Review Clinician PAY RANGE: LVN/LPT $31.50-37.50 Per Hour RN/LCSW/LMFT/LPCC ... $54.00-64.00 Per Hour REPORTS TO: Director of Utilization Review DESCRIPTION OF POSITION: Work as member of multi-disciplinary...in a clear, concise, organized and timely manner. + Medical Necessity: Attend Treatment Team on a daily basis… more
- YesCare Corp (Brentwood, TN)
- …pre-established review parameters under the direction of the YesCare Medical Director. + Identify and document comparisons with community standards, regionally ... contracts and involved in the implementation of a comprehensive outpatient/inpatient review process utilizing criteria based review standards and standards… more