- Novo Nordisk Inc. (King Of Prussia, PA)
- …Relationships Externally, the DCS I maintain relationships with physicians, physician assistants, nurse practitioners, medical assistants, pharmacists, nurses and ... level impact Demonstrates understanding of the local payer market including Medicare , Commercial and Medicaid benefit designs, Payer Coverage, Prescription Coverage… 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
- The Cigna Group (Denver, CO)
- …conduit to the providers and the individual that represents Cigna Medicare Advantage. The Provider Performance External Representative's responsibilities include: + ... Supporting the development, management and oversight of the physician / provider network in his/her assigned **territories.** + Establishing and managing strong,… 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 (Phoenix, AZ)
- …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
- The Cigna Group (Seattle, WA)
- …include: + Supporting the development, management and oversight of the physician / provider network in his/her assigned Washington territory. + Establishing and ... for and participates in meetings with providers, provider staff, and/or physician leadership including creating and delivering presentations. + Collaborating with… more
- BAYADA Home Health Care (Tucson, AZ)
- …and shall provide current proof of such registration upon Hospice's request. 6. Medicare and Medicaid Eligibility: Hospice Physician is and shall always remain ... a qualified Medicare and Medicaid provider. Hospice Physician represents and warrants that they have never been...document a patient's terminal illness. In such cases, Hospice Physician shall review the patient's clinical information… 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
- Penn Medicine (Philadelphia, PA)
- …hospital through teaching, consulting, and advising the care management and utilization review departments and the hospital leadership. The Physician Advisor ... Are you living your life's work? **Summary:** + The Physician Advisor is a key member of the healthcare...level of care including initial level of care, secondary review , and as requested by case management. Review… 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
- 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
- CenterWell (Jackson, MS)
- …on teamwork and providing a positive and welcoming environment for all. The Physician Lead serves as a health-care professional and capable of handling a variety ... of health-related problems. The Physician Lead works on problems of diverse scope and...inquiries, requests, and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality… more
- CenterWell (Austin, TX)
- …with the care team through daily huddles. + Helps Regional Medical Director (RMD), Physician and Center Administrator in setting a tone of cooperation in practice by ... defined by Clinical Leadership. + Meets with RMD about quality of care, review of outcome data, policy, procedure, and records issues. + Participates in potential… 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
