- Mohawk Valley Health System (Utica, NY)
- … regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of...and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides… more
- Baptist Memorial (Memphis, TN)
- …BMHCC. Physician Advisor communication may be necessary to provide further clinical review from the physician perspective as needed in preparation of writing ... Overview Specialist -Denial Mitigation II RN Job Code: 21432 FLSA...clinical meetings, reach out to payer contacts, communicate with physician clinics to obtain additional documentation to support appeal,… more
- Veterans Affairs, Veterans Health Administration (Fayetteville, NC)
- …improvement certification. Current mastery level certifications include: Certified Coding Specialist (CCS),Certified Coding Specialist - Physician -based ... medical data from patient health records in the hospital setting, and/or physician -based settings, such as physician offices, group practices, multi-specialty… more
- HCA Healthcare (Dallas, TX)
- …staff performance evaluations. + Acts as manager in charge as assigned. + Provides review and guidance on physician order sets and other evidenced based ... in daily multidisciplinary and bedside rounds + Completes drug utilization reviews to promote rational drug therapy and implement...we encourage you to apply for our Clinical Pharmacist Specialist BMT opening. We promptly review all… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Enhanced Care Management Clinical Specialist II Job Category: Clinical Department: Care Management...Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM),… more
- HCA Healthcare (Richmond, VA)
- …acute inpatient rehabilitation services prior to returning home. The Clinical Rehabilitation Specialist will review these patients daily until they have strong ... clinical evidence to request a physician order for a formal pre-admission assessment for acute...we encourage you to apply for our Clinical Rehab Specialist PRN opening. We review all applications.… more
- Abbott (Plano, TX)
- …required clinical information for authorizations. + Work with respective carrier's utilization review department to obtain appropriate authorizations. + Assist ... insurance, Worker's Compensation and Medicare guidelines pertaining toProspective and Retrospective Utilization Review . Some experience in medical deviceor DME… more
- HCA Healthcare (Nashville, TN)
- …treatment is reimbursed by contacting managed care organizations and completing initial utilization review . Documents in Midas as required. Involves mobile ... on face to face or telemedicine assessment completed and physician consult. + Provides a thorough clinical review...patients in regard to managed care organizations + Conducts utilization review for managed care cases in… more
- UPMC (Pittsburgh, PA)
- …while also considering outcomes of the programs. + Develop and conduct Drug Utilization Review (DUR) activities, Medication Therapy Management (MTM), and other ... and enhance clinical reporting programs, including but not limited to physician specific reporting, alternative prescribing programs for utilization , assigned… more
- HCA Healthcare (Campbell, CA)
- …find this opportunity compelling, we encourage you to apply for our Contract Specialist opening. We promptly review all applications. Highly qualified candidates ... worth of each individual is recognized. Submit your application for our Contract Specialist opening with HCA Healthcare today and find out what it truly means… more