- Veterans Affairs, Veterans Health Administration (Indianapolis, IN)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... VHA Education Loan Repayment Services program office after complete review of the EDRP application. Former EDRP Participants are...responsible for the oversight of all aspects of cardiac medical care delivered to patients under their care. Provide… more
- Nuvance Health (Danbury, CT)
- …Appeals:* * *Root Cause Analysis:* Lead a specialized team to thoroughly investigate claims denied for medical necessity on bedded patients, identify root causes ... conversion rates, medical necessity outreach, and feedback to the utilization review team on denial outcomes. * *Discharge Planning & Social Work:* *… more
- The County of Los Angeles (Los Angeles, CA)
- …(CDU), DHS hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty and subspecialty. In ... its direct clinical services, DHS also runs the Emergency Medical Services (EMS) Agency and the County's 911 emergency...REQUIREMENTS: + A License to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- LA Care Health Plan (Los Angeles, CA)
- …case management referrals (5%) Performs prospective, concurrent, post-service, and retrospective claim medical review processes. Utilizes clinical judgement, ... Medical Director, on requests where determination requires extended review . Collaborates with the inpatient care team for facilitation/coordination of patient… more
- Veterans Affairs, Veterans Health Administration (Jamaica Plain, MA)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... an enthusiastic part time internist with a passion for medical education in Boston, MA. Physicians provide longitudinal care...care are encouraged. Each physician is assigned a registered nurse , clinical associate, scheduler and also has access to… more
- HCA Healthcare (Kissimmee, FL)
- …Assists appropriate medical staff and nursing committees in the resolution of peer review , medical quality of care and nursing quality of care issues posing ... and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low… more
- WMCHealth (Poughkeepsie, NY)
- …related to medical staff PI + Screens cases to identify issues for physician review , using criteria established by the medical staff and the NYS DOH. + ... a potential lawsuit, etc.) and alerts the department director, medical staff leadership, and claims manager. +...etc.) and alerts the department director, administration, and the claims manager. Initiates a more thorough review … more
- University of Miami (Miami, FL)
- …apply for a faculty or staff position, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Department ... with protocols and regulations. CORE JOB FUNCTIONS + Submits claims to insurance companies and follows up on outstanding...+ Recommends policy and procedural changes to management for review as needed. + Adheres to University and unit-level… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …experience in Utilization Management, Referral Management, Authorization/Denials, or Medical Claims Processing/Insurance Referral. Additionally, qualified ... + Perform referral review duties, seeking guidance from the product line nurse (s), and other members of the healthcare team and MTF points of contact as… more
- City of New York (New York, NY)
- …compensability of treatment as it relates to the claimant's work injury and assist with medical case management of claims . Review and process high value and ... Compensation Division are responsible for all medically related issues for medical management of workers' compensation claims . Responsibilities include: Consult… more