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ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services.
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The physician reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client specific policies, nationally recognized evidence-based guidelines, and standards of care.
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Experience in Utilization Management, Case and Disease Management with knowledge of Medicaid and Medicare programs. A Physician Reviewer who will provide principal leadership and clinical expertise to operations relating to the peer review process, utilization review activities, and other activities requiring clinical leadership and consultation.
$125 an hourRemoteExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Three (3) or more years of any individual or combined experience in Quality Assurance, Utilization Management, Case Management, and/or provider liaison duties, preferably in an HMO or Managed Care setting.
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The Case Reviewer is responsible for reviewing the affected applicant’s FEMA NCS application and come to an eligibility determination. THIS IS A TEMPORARY EMPLOYMENT OPPORTUNITY Position Summary: Tidal Basin seeks a competent Case Reviewer to join the team supporting the Client’s Non-Congregate Sheltering (NCS) program.
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Knowledge of federal contract accounting - FAR, FEHBAR, CAS, GAAP, and ASBCA case law, contract administration requirements, and experience researching compliance requirements and issues related to these.
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Our reviewers are compensated on a per-case basis as a 1099 independent contractor. Physician Specialties: Radiation Oncology, Cardiology, Rheumatology, Ophthalmology, Otolaryngology, OB/GYN, Hematology/Oncology JOB SUMMARYUtilizes clinical expertise and reviews insurance appeals, as well as prospective and retrospective claims.
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Escalated alerts are assigned to a Fraud department Case Reviewer. Escalated alerts are assigned to a Fraud department Case Reviewer. Obeys all applicable federal laws, rules, and regulations relating to Anti-Money Laundering (AML) including the Bank Secrecy Act (BSA.
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The Coordinator will compile and process all E-TARs according to guidelines, log all requested TARs in Medical TAR log (Lotus), notify physician of Medical denials, log in all TARs in CPSI, process all deferred TARs, communicate with medical nurse reviewer accordingly, copy medical records for TAR review and fax all requested TARs for new admissions, concurrent and discharge in a timely manner.
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Two years previous experience as a Case Manager or Utilization Reviewer required. Certification as a Case Manager (CCM) or American Case Management certification (ACM) preferred.
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Quality Program Nurse, RN enforce DHCS regulatory requirements as pertaining to Facility Site Review (FSR) and Medical Record Review (MRR) criteria. Pay RangeUSD $43.87 - USD $58.13 /Hr. OverviewWhat you can expect.
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May serve as a technical advisor, OJT coach, classroom instructor, or reviewer, and provide technical assistance on systemic problems and inconsistencies in IRMs. Responds to taxpayer's inquiries regarding preparation of a variety of tax returns, related schedules and other documentation; resolves account inquiries; advises taxpayers of enforcement actions; manages sensitive case problems designated as requiring special case handling.
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Experience conducting employment tax examinations (e.g., non-filers, 1120S officer compensation, worker classification, tip audits with multiple establishments, accountable plans, mergers & acquisitions, advanced executive compensation, advanced fringe benefits, and large case audits.
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Maintains and coordinates Medicaid state submission forms for presentation to on-site reviewer and files them accordingly or as per facility's procedure. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and functions, in both managed care and non-managed care environments.
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Job Description: ACT1 Federal is seeking a Surgical Case Nurse Reviewer (SCNR) to support our customer at the Medical Treatment Facility (MTF) at Eglin Air Force Base (AFB). Position Title: Surgical Case Nurse Reviewer.
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