- MaineGeneral Health (Augusta, ME)
- …of Certified Medical Examiners. + be certified or become certified as a Medical Review Officer (MRO). + have a strong understanding of regulations governing ... Job Summary:As a Physician in an affiliated medical practice, provides medical services to patients in an assigned area. Job Description: Occupational Medicine… more
- Veterans Affairs, Veterans Health Administration (East Orange, NJ)
- …with PACT to ensure timely closure of clinic appointments, scan Non-VA medical documentation, review (ICB) insurance capture buffer daily, address (RTC) ... NJ VA Healthcare System is hiring for an Advanced Medical Support Assistant for the East Orange VA ...verbal information, per HIPAA requirements. The Advanced MSAs will review the clinics appointment schedule to ensure that clinic… more
- US Tech Solutions (Columbia, SC)
- …using indicated protocol sets or clinical guidelines. + Provides support and review of medical claims and utilization practices.. **Responsibilities:** + May ... provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a reasonable… more
- Ascension Health (Appleton, WI)
- …and continuous improvement of services, policies, processes, and programs, including medical practice review , governance, credentialing, privileging, peer ... of physician professional conduct. Ensures adherence and completion of medical staff decisions regarding peer review and...completion of medical staff decisions regarding peer review and physician behavioral issues. + Leads the development… more
- MyFlorida (Tallahassee, FL)
- …filed in the State of Florida. Training is provided on relevant policy, medical review and vocational evaluation. Potential advancement based on successful ... OPS MEDICAL DISABILITY EXAMINER - 64858502 Date: Nov 18,...No: 865406 Agency: Department of Health Working Title: OPS MEDICAL DISABILITY EXAMINER - 64858502 Pay Plan: Temp Position… more
- Point32Health (Canton, MA)
- …prepayment investigations, involving internal and external research, detailed data analysis, review of medical records, and interviews of members, providers, ... schemes. + Handling substantial prepayment claims including extensive administrative tasks, review of medical records, and communicating with providers through… more
- Dignity Health (Bakersfield, CA)
- …backup support to the Medical Director of Utilization Management in medical review activities, peer-to-peer consultations, appeals and grievances and other ... offices primarily in the Bakersfield/Central CA region.** **Position Summary:** The Medical Director of Physician Engagement is responsible for developing and… more
- BayCare Health System (Tampa, FL)
- …related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays ... trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions as the primary… more
- HonorHealth (AZ)
- …high quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, ... area. The comprehensive network encompasses nine acute-care hospitals, an extensive medical group with primary, specialty and urgent care services, a cancer… more
- Humana (Helena, MT)
- …management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present ... to the clinical operations team and healthcare organization. The Medical Director's work includes computer based review ...The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more