- WTW (Fort Lee, NJ)
- …leading direct-to-consumer insurance services business, specializing in the distribution of Medicare Advantage, Medicare Supplement and Life & Supplemental ... outputs meet quality, compliance, and business expectations before reaching the Senior Director for final strategic oversight. This position will act as the bridge… more
- CenterWell (New Smyrna Beach, FL)
- … medical expertise with the care team through daily huddles. . Helps Regional Medical Director (RMD) and Center Administrator (CA) in setting a tone of ... medicine, continuity of care, health maintenance, and disease prevention. Keeps a medical history and medical records. Refers the patient to specialists… more
- Community Health Systems (Franklin, TN)
- …and communication skills. + Knowledge of The Joint Commission (TJC) standards, Medicare Conditions of Participation, and medical staff bylaws. **Licenses and ... is responsible for ensuring the accuracy, completeness, and integrity of medical records by reviewing, indexing, and validating documentation within the Electronic… more
- Dana-Farber Cancer Institute (Brookline, MA)
- Under the general supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to clinical denial ... management. The individual is responsible for managing medical denials by conducting a comprehensive review of relevant...trends; including denials that have been escalated to the Medicare Administrative Law Judge (ALJ). + Represent DFCI at… more
- City and County of San Francisco (San Francisco, CA)
- …may include, but are not limited to: + Disease Prevention and Control Senior Specialist/ Medical Director + Provides clinical oversight of a unit or clinic within ... limited to Quality Assurance activities; prepares or reviews detailed and complex medical and technical records and reports. + Senior Family Physician, Internist or… more
- Beth Israel Lahey Health (Plymouth, MA)
- …Initiates and maintains consistent communication with the attending physician, the Hospice Medical Director , the hospice pharmacist(s), other members of the IDG ... family care + Proactively informs Clinical Supervisor or Clinical Director of unusual or potential problems. + Works with...patient care issues, goals and plans in the electronic medical record and exports data to be shared with… more
- LA Care Health Plan (Los Angeles, CA)
- …the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires extended review. ... based on clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses members for admission… more
- University of Rochester (Albany, NY)
- …Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 910397 URMC Medical Staff Services Work Shift: UR - Day (United States of America) Range: ... activities to ensure quality in conducting, maintaining, and communicating the medical and allied health professional staff credentialing, privileging, and primary… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case ... identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate communication techniques with members and… more
- State of Georgia (Fulton County, GA)
- …Fraud Division. Job Summary Under the direction of the Fraud Unit Director , assists in healthcare investigations by: reviewing provider and recipient records, by ... making determinations of medical necessity, by making determinations as to whether services...Medicaid Program; state and federal laws and policies governing Medicare and Medicaid. + Applies appropriate regulations, policies, and… more