- Amgen (Philadelphia, PA)
- …HUB, providing live one-on-one coverage support + Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer ... prior authorization to appeals/denials requirements and forms. + Review patient-specific information in cases where the site has...the products are covered under the benefit design (Commercial, Medicare , Medicaid). + Serve as a payer expert for… more
- Fresenius Medical Center (Kennesaw, GA)
- …set. + Nurse Manager, assuring proper chart documentation is established. + Physician , review of policies regarding chart/charge sheet. + Monitors adherence ... in the negotiation of third party and direct contracts. + Meets / reviews with Physician groups to review contract content. + Oversees centralized data base that… more
- Ellis Medicine (Schenectady, NY)
- …Level of Care and status on all patients through collaboration with Utilization Review RN + Contacts the attending physician for additional information if ... by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and social workers for… more
- Central Maine Medical Center (Rumford, ME)
- …implements, and evaluates the needs of patients for discharge planning and utilization review . This includes those who may have Medicare , Medicaid, HMO, or ... have an ongoing caring relationship with the patient. Utilization review procedures include those stated for discharge planning in...discharge planning in addition to knowledge of criteria for Medicare , Medicaid coverage and that of HMO or private… more
- CenterLight Health System (NY)
- …areas for Center Light Healthcare System. + Works with Site Medical Director/Attending Physician and Nursing in QA review of their respective disciplines as ... appropriate. + Review and analyze monthly financial reports submitted by Medicare related to diagnostic data. + Present HCC/RAF performance results and findings… more
- New York State Civil Service (Middletown, NY)
- …a higher-level Psychiatrist or Physician . http://www.linkedin.com/company/nys-office-for-people-with-developmental-disabilities/posts/?feedView=all #LI-JL2 Minimum ... Credentials will be reviewed at the time of interview.Background Investigation/Justice Center Review : In some agencies, the names of all prospective employees will*… more
- US Tech Solutions (AZ)
- …**Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. ... responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for… more
- US Tech Solutions (May, OK)
- **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You ... responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for… more
- US Tech Solutions (May, OK)
- …or denied prior authorizations. **Responsibilities:** + Ensure accuracy of case setup and clinical review of Medicare appeals cases. + Review internal notes ... for clinical information to decision cases + Utilize work instructions and Medicare guidelines for accurate case processing. + Comply with CMS mandated timelines… more
- New York State Civil Service (Thiells, NY)
- …and procedures when needed to ensure the provision of quality care. * Review of lab work, specialty consults, hospital discharges, medical visit summaries and ... the group home, the hospital, the rehabilitation setting and/or community providers.* Review and approval of discharge summaries prior to accepting an individual… more
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