- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …avoidable days, trends, and actions to UR Committees, as appropriate * Partners with Physician Advisor to engage in second level review and working with ... *_SUMMARY:_* We are currently seeking a*Utilization Review Manager* to join ourTransitional Care Team.Thisis a...to be medically inappropriate. Including, but not limited to; Peer -to- Peer as appropriate, written appeal letters when… more
- Beth Israel Lahey Health (Plymouth, MA)
- …and identifies trends/root causes of denials for discussion with the internal team, physician advisor and the Utilization Review Committee as appropriate. + ... you're making a difference in people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who We Are:** At… more
- HCA Healthcare (Tampa, FL)
- …to join an organization that invests in you as a Pro Fee Coding Quality Review Educator? At Parallon, you come first. HCA Healthcare has committed up to $300 million ... are looking for a dedicated Pro Fee Coding Quality Review Educator like you to be a part of...for innovation, knowledge sharing and CCU coding workflow among peer groups. + Stay abreast of coding/billing regulatory requirements… more
- Beth Israel Lahey Health (Plymouth, MA)
- …using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to ... and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established...Acts as a liaison between physicians and payers, coordinating peer -to- peer phone calls. + Collects and compiles… more
- Bozeman Health (Bozeman, MT)
- …management of the credentialing life cycle and a robust, fair, and timely peer review program. Qualifications: Required: + Bachelor's Degree in healthcare ... hire. + Three (3) years of progressive responsibility in medical staff services, peer review processes, credentialing, and credential verifications. + Two (2)… more
- HCA Healthcare (Nashville, TN)
- …**Job Summary** We are seeking a diligent and experienced Senior Manager, Clinical Review , Quality Control to ensure the quality and accuracy of clinical reviews. ... of our clinical processes. The Senior Manager will analyze physician documentation, assist with quality control and oversight, and...as a subject matter expert, guiding clinical appeal and peer -to- peer processes with expertise and insight. +… more
- Sharp HealthCare (San Diego, CA)
- …improvement and outcomes studies as directed by the Quality Management + Committee, Peer Review Committee and Chief Medical Officer and reports findings in ... review , utilization management, and concurrent and retrospective review Process. Performs and mentor's physician training...management teams. + Co-Chairs with the CMO CPTAC and Peer Review Committees. + Partners with Senior… more
- AdventHealth (Maitland, FL)
- …is not met to include review of journal articles, compendia and/or peer review to justify medical necessity approval + Reviews clinical records when ... value you'll bring to the team:** + Responsible for review of chemotherapy regimen/treatment orders and determines insurance benefits...up on authorization request directly with a payor. Escalates peer to peer (insurance company physician… more
- Houston Methodist (Houston, TX)
- …method of treatment. + Performs preliminary screening examinations, excluding ocular, for physician review including, but not limited to, central and peripheral ... of the eye using a slit lamp and notes variations from normal for physician review . + Arranges for laboratory and other tests, ophthalmic photography, inpatient… more
- Houston Methodist (Cypress, TX)
- …care improvement. Provides physician leadership to the quality staff in preparation and review of cases for peer review as needed. **SERVICE ESSENTIAL ... safety. The CQO position collaborates with the System CQO and other system physician leadership in quality and patient safety to support the development of the… more