- CenterWell (Las Vegas, NV)
- …with administrative coverage including but not limited to prescription refills, document review , and review of imaging and laboratory results. + Follows ... by Clinical Leadership. + Meets regularly with Associate Medical Director to review job performance. + Participates in potential growth opportunities for new or… more
- Molina Healthcare (Ann Arbor, MI)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services ... E** **X** **PE** **R** **I** **E** **N** **C** **E:** + Peer Review , medical policy/procedure development, provider contracting experience. + Experience with NCQA, … more
- CenterWell (Norfolk, VA)
- …quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities in care, ensuring clinical assessments ... experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS , meeting local and organizational goals + Personally deliver high-quality primary… more
- CenterWell (Daytona Beach, FL)
- …experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in care, ensuring clinical ... experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS , meeting local and organizational goals *Personally deliver high-quality primary care… more
- ZoomCare (Tigard, OR)
- …our values: Awesome, Creative, Respectful, Team Players, Get it Done. + Review outpatient clinical documentation to identify gaps in specificity, clarity, and ... and common disease processes necessary for accurate code assignment and documentation review . + Proficiency in working with electronic health record (EHR) systems… more
- CVS Health (Springfield, IL)
- …to establish a sustainable competitive business advantage by supporting the plan goals. Review , interpret and analyze data and trends at State level in: UM, CM, ... Have oversight of the design, development, and deployment of Care Models and review medical care provided to Enrollees and medical aspects of the Provider Contract.… more
- Veterans Affairs, Veterans Health Administration (Chesapeake, VA)
- …care team (LPN, RN, Clinician/Provider, Social worker, Pharmacist, etc.). to review the clinic utilization by using various report clinic utilization statistical ... (CTM), recall delinquency report, secure messages, VeTEXT, VAR, as well as SAIL/ HEDIS metrics that directly impact the PACT team's metrics for patient care. Other… more
- CVS Health (Lansing, MI)
- …to establish a sustainable competitive business advantage by supporting the plan goals. 2. Review , interpret and analyze data and trends at State level in: UM, CM, ... Have oversight of the design, development, and deployment of Care Models and review medical care provided to Enrollees and medical aspects of the Provider Contract.… more
- Molina Healthcare (Layton, UT)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services ... Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider contracting experience. + Experience… more
- Molina Healthcare (Covington, KY)
- …(clinical operations) teams including Utilization Management (prior-authorization, inpatient review ) and Care Management (case/health management and transition of ... chemical dependency programs. + Continually refines operational processes and champions review of team processes, workflows, and activities. + Articulates project… more