- St. Luke's Health System (Boise, ID)
- …aspects of the department, including organizing and conducting programs and establishing procedures for medical staff peer review functions across the ... health system. + Liaison and resource for medical staff peer review committees and the committee chairs across the St. Luke's Health System for peer … more
- Trinity Health (Boise, ID)
- …current and past case reviews and subsequent requested reports, and integration of Peer Review process with medical Records processes. Communicate to ... of care. **We are seeking to hire a temporary Peer Review Coordinator!** As a Peer...and from all physicians and their Office of Medical Affairs and Medical Records Services, and… more
- Evolent Health (Boise, ID)
- …and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting...Clinical Reviewers. + Ensures documentation of all communications with medical office staff and/or MD provider is… more
- Humana (Boise, ID)
- …put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work ... Medical Director will collaborate with clinicians and support staff to provide Humana members with optimal value based...how to operationalize this in their daily work. The Medical Director's work includes computer based review … more
- Evolent Health (Boise, ID)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... rationale for standard and expedited appeals. + Discusses determinations ( peer to peer phone calls) with requesting...(NCQA) guidelines. + Ensures documentation of all communications with medical office staff and/or MD provider is… more
- R1 RCM (Boise, ID)
- …client facilities navigate the path to compliant revenue by reviewing payor peer -to- peer cases. Every day you will review cases for which authorization has ... clinical evaluation of the request as a whole. + Review and respond to the payor and customer in...multiple specialties. + Serve as a clinical resource to medical and case management staff by providing… more
- Idaho Division of Human Resources (Boise, ID)
- …analytical data. - Train, mentor, and provide inspection support and peer review for regional office hazardous waste staff . . Enforcement duties: - Prepare ... to successful completion of probation. This position will require a medical surveillance baseline exam. Position: The Idaho Department of Environmental Quality… more
- Highmark Health (Boise, ID)
- …data elements to satisfy statistical requests by the hospital, health system, medical staff , etc. and enters all coded/abstracted information into designated ... Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This job performs thorough medical record review to abstract medical and demographic… more
- Humana (Boise, ID)
- …assesses and communicates information regarding actuarial/business risks across the organization. Provides peer review and counsel on a wide variety of company, ... interpretation and implementation of CMS guidance, and implementation and execution of review standards and controls to minimize compliance risk associated with the… more
- KPMG (Boise, ID)
- …throughout the contract management process, escalating to leadership when necessary; review client redlines and client terms for specific contracts by leveraging ... playbooks, and when required, escalate clauses for review to Subject Matter Experts, Risk Management, Independence, and Office of General Counsel, ensuring their… more
- Cardinal Health (Boise, ID)
- …operations and supervises professional employees, frontline supervisors and/or business support staff . + Participates in the development of policies and procedures ... work processes, outcomes, and customers. + Interacts with subordinates, peer customers and suppliers at various management levels may...benefits and programs to support health and well-being. + Medical , dental and vision coverage + Paid time off… more
- Highmark Health (Boise, ID)
- …Active participation in on-going interdisciplinary communication specific to each patient with review of patient status and plan of care. + Directing and organizing ... + Adherence to Allegheny Health Network policies and procedures regarding medical record documentation and Performance Improvement activity. + Home Infusion visits… more