- CVS Health (Tallahassee, FL)
- …of patients with severe, complex, and/or treatment resistant illnesses through peer review and educational interventions. * Work with medical director teams focusing ... on inpatient care management, clinical coverage review , member appeals clinical review ,...multiple stakeholders. * Help achieve or exceed all applicable HEDIS , Stars and local state performance targets and goals… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range of medical ... clinical reviews with attending physicians or other providers to discuss review determinations with providers and external physicians. + Conduct clinical appeal… more
- CVS Health (Downers Grove, IL)
- …to obtain crucial or required information from Providers, such as HEDIS , Revalidation, Grievance and Appeals, SIU, etc. Coordinate provider status information ... aligns PE/Network functions with Operations and Claims as needed + Research, review , and prepare responses for all governmental, regulatory and quality assurance… more
- University of Miami (Miami, FL)
- …preferred + Completion of Medicare annual wellness exam documentation preferred + Knowledge of HEDIS Quality Care Gaps - review and closure preferred + Knowledge ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . APP, Supervisor -… more
- Commonwealth Care Alliance (Boston, MA)
- …CCA for tracking and metrics.** **Obtain documentation from outside EMRs in preparation of HEDIS review , ACA and MDS assessments.** **Request and review ... data entry into CCA's Electronic Medical Record (EMR)** **Request and review EMR from partnering organizations to obtain pertinent member documentation (narrative… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... members, including participating in weekly project team meetings. + Review the status of projects and issues on an...you will: + Build and maintain Clinician's workflow and HEDIS quality measure for Medicare Advantage programs + Build… more
- 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
- CareFirst (Baltimore, MD)
- …Utilizes MCG to act as a resource for the nurses to conduct concurrent review for medical necessity and appropriate level of care for Commercial and Government lines ... + Oversees associates conducting care coordination activities including concurrent review utilizing MCG. Collaborates with CareFirst medical directors and… 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
- Queen's Health System (Honolulu, HI)
- …records via secured file transfer protocol (FTP) sites for quality and payor review of records ( HEDIS /Risk Adjustment/RAC). II. TYPICAL PHYSICAL DEMANDS: * ... business. * Upon request, releases records electronically for admitted patient's payor concurrent review of records. * Upon request, releases electronic copies of… more