- Dartmouth Health (Bennington, VT)
- …leading professional organizations, including The Joint Commission, the Centers for Medicare and Medicaid Services and the American Nurses Credentialing Center. ... for the Professional Staff and Code of Conduct. * Review records and detailed medical history from patient(s). *...years) - Active hospital staff membership * Area of Interest: Physician * FTE/Hours per pay period:1.00 - 1.00 -… more
- Marshfield Clinic (Iron Mountain, MI)
- …in the world!** **Job Title:** Patient Access Representative - Wound ( Physician Services) **Cost Center:** 603181114 IMHos-HBOT-Wound **Scheduled Weekly Hours:** 0 ... are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position._ **Minimum… more
- CenterLight Health System (Ridgewood, NY)
- …PURPOSE: Under the direction of the Chief Medical Officer, the Site Physician is responsible for the professional, organizational, and administrative aspects of ... team meetings. + Develops and participates in the Utilization Review of medical services provided by CLHC/DTC. + Develops...+ Must have a Medicaid Provider ID and a Medicare Provider ID in good standing. Physical Requirements Individuals… more
- Sanford Health (Rapid City, SD)
- …(Tues-Fri) * Hospital responsibilities - inpatient care and assists in surgical clearance/chart review as needed * New grads are encouraged to apply, those with ... preferred * Must be eligible for licensure as a Physician Assistant or Nurse Practitioner in the State of...abreast of regulatory processes and payer systems such as Medicare , Medicaid, managed care, and private sources, as applicable.… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I ... information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're working in… more
- Houston Methodist (Houston, TX)
- …to the Physician Advisor (or services) for appropriate second level review , peer-peer discussions, and payer denial- appeal needs. Consults with physician ... + Recent work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare , Medicaid, and Managed Care… more
- The County of Los Angeles (Los Angeles, CA)
- … Organization guidelines and the Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician member of the ... UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR… more
- Medical Mutual of Ohio (OH)
- …of stay and level of care. + Extrapolates and summarizes medical information for physician review or other external review . + Generates appropriate written ... insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Working under limited… more
- Catholic Health Initiatives (Houston, TX)
- …assist in determination of clinical appropriateness for level of care and Medicare /Medicaid and Managed Care related issues 3. Reviews all patient documentation in ... denial for reimbursement. Assess individual situations and makes appropriate referrals to physician advisor. Implements appeal process 4. Serves as resource for case… more
- HCA Healthcare (Nashville, TN)
- …appeal criteria is met in compliance with departmental policies and procedures + Review Medicare Recovery Audit Contractor (RAC) recoupment requests and process ... Submit your application for the opportunity below:Clinical Denials Coding Review SpecialistParallon. **Benefits** Parallon, offers a total rewards package that… more