- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Under general ... supervision,** **performs administrative functions in support of assigned utilization review or case management department. Receives and reviews correspondence from… more
- The Cigna Group (Sunrise, FL)
- …conduit to the providers and the individual that represents Cigna Medicare Advantage. The Provider Performance Enablement Lead Analyst's responsibilities include: + ... inform external partners. + Supporting the development, management and oversight of the physician / provider network in the assigned **Treasure Coast, FL and SW FL… more
- Vanderbilt University Medical Center (Nashville, TN)
- …Revenue Cycle, Consulting or Auditing in a Large Healthcare Environment, hospital, physician practice, third party payer, Medicare intermediary, health insurer, ... data to support analytical reporting to senior business operational leaders and physician leadership regarding: + Audit results to outside regulators, attorneys, and… more
- Insight Global (Cincinnati, OH)
- Job Description Insight Global is looking for a Medicare Biller for a contract to hire opportunity in the Blue Ash area of Cincinnati. This person will be joining a ... claims for a large health system (both in patient hospital and out patient physician claims). This person will be primarily responsible for medicare billing,… more
- Molina Healthcare (Long Beach, CA)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services… more
- VNS Health (Manhattan, NY)
- …Investigation Unit on issues related to Fraud, Waste, and Abuse of Medicare /Medicaid services.* Collaborates with pharmacy services to review PBM activities ... Do * Provides oversight of VNS Health Plans clinical components for utilization review and decision making.* Leads in establishing medical policies for VNS Health… more
- The Cigna Group (Bloomfield, CT)
- …for the transplant members assigned to their caseload. This will require review of clinical information and correspondence with facilities to make determinations on ... + Establishes a collaborative relationship with client (plan participant/member), family, physician (s), and other providers to determine medical history and current… more
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** **The Utilization Review Physician collaborates with the healthcare team in the** **management and resolution of activities that assure the ... Hackensack UMC. These include but are not limited to utilization review ,** **hospital reimbursement, clinical compliance, case management, and transitions of care,… more
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity ... and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and transitions of care,… more
- CareOregon (Portland, OR)
- …care costs and increase provider/care team satisfaction. Housecall Providers has saved Medicare millions of dollars, while providing better care to our patients, ... diseases. This trend will continue as roughly 10,000 baby boomers a day enter the Medicare system. If you receive an offer of employment for this position, it is… more
- AdventHealth (Ocala, FL)
- …**.** **EDUCATION AND EXPERIENCE PREFERRED:** **.** **REQUIRED:** **.** Graduate of a physician assistant program approved by the Accreditation Review Commission ... Inpatient consultation and admission at the direction of the collaborating physician .** Documentation of all patient encounters by computerized progress notes, brief… more
- Magellan Health Services (San Diego, CA)
- Schedules Physician Clinical Review (PCR) utilization management reviews (including peer to peer telephone discussions and provider outreach discussions) for ... Management clients for medical pharmacy/specialty, PBM, MRX Navigate, and Medicare Part D areas of business. Performs follow-up to...performed on a daily basis by account, type of review , physician clinical reviewer and outcomes. +… more
- Dartmouth Health (Keene, NH)
- Overview Associate Medical Director - Cheshire Hospital Medicine Physician Advisor The Cheshire Medical Center’s Department of Hospital Medicine is a collaborative ... 5 APP's. This Section offers an exciting opportunity for a dynamic and motivated Physician to join its group.Five or more years of experience in inpatient care is… more
- CenterWell (Fort Worth, TX)
- …a part of our caring community and help us put health first** The Physician serves as a health-care professional and capable of handling a variety of health-related ... problems. The Physician work assignments involve moderately complex to complex issues...Clinical Leadership. Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues.… more
- Prime Therapeutics (Columbus, OH)
- …fuels our passion and drives every decision we make. **Job Posting Title** Physician Clinical Reviewer- GI- REMOTE **Job Description Summary** Key member of the ... utilization management team, and provides timely medical review of service requests that do not initially meet the applicable medical necessity guidelines. Routinely… more
- Conviva (Jacksonville, FL)
- …a part of our caring community and help us put health first** The Physician serves as a health-care professional and capable of handling a variety of health-related ... problems. The Physician work assignments involve moderately complex to complex issues...Leadership. . Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues.… more
- Mount Sinai Health System (NJ)
- …with their job descriptions and the VMG Compact + Participate in the annual physician performance review process in Oncology Services + **Engage in the ... Health System mean our doctors collaborate with the top physician leaders in medicine today. The Valley Hospital is...medical group governance, quality assurance, risk management and peer review .** + Advocate on behalf of VMG Oncology Services… more
- Catholic Health Services (Melville, NY)
- …hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the ... Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR), discharge planning (DP), LOC and clinical documentation. Works… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …tasks as assigned by the Associate Medical Director of the Physician Psychologist Review Unit + Adhere to NCQA, URAC, Medicare and other regulatory standards ... At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas… more
- Mohawk Valley Health System (Utica, NY)
- …of care, patient billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance ... PHYSICIAN ADVISOR Department: CASE MANAGEMENT Job Summary The...of admission and continued stay, severity, and morbidity/mortality. + Review patient status when admission criteria is non-sufficient for… more