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Lead Tenet Utilization Review Teams market structure and operations management to effectively support utilization review and authorization confirmation functions to promote an appropriate level of care and prevent payer denials.
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Extensive experience in upstream Batch Record Review in a Cell & Gene Therapy environment. We are seeking a highly skilled and qualified individual to join our team as a Batch Record Review Specialist in a Cell & Gene Therapy environment.
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Description Summary: The RN Utilization Review II is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services.
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When naviHealth is delegated for utilization management, review referral requests that cannot be approved for continued stay and are forward to licensed physicians for review and issuance of the NOMNC when appropriate.
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The Utilization Review Nurse provides the highest level of clinical service both internally and externally to promote quality, medically necessary, cost-effective care. Research status of vague or questionable procedures and present to the Chief Medical Officer/Physician Peer Reviewer for review.
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General Functions: + Experience and knowledge of clinical guidelines/criteria and the accurate application during a clinical review. + Health plan based utilization review.
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Plan Review Section review the engineering proposals for various types of projects submitted by different City and State Agencies, Private Developer, Transit/MTA, Port Authority, EDC, etc.
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Perform clinical screening to determine the expedited review of grievance and appeals. Assist the Grievance and Appeals Department in completing clinical appeals case summaries for submission to the Independent Review Entity, State Hearings and other escalated appeals.
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Biology Research Associate requires: Good working knowledge of cGMP regulations is required. Biology Research Associate needs BS requires 3-5 years and MS requires 1-3 years of previous related experience.
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Posted job title: Rn Utilization Review, Clinical. VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Secaucus, New Jersey. Conducts review of requests for prior authorization of health services, as required in certain product lines, and prepares written responses consistent with regulatory requirements.
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May perform other regulatory / Institutional Review Board duties, budgeting duties, and assisting with patient research billing and reconciliation. The Clinical Research Coordinator II works independently providing study coordination including screening of potential patients for protocol eligibility, presenting non-medical trial concepts and details, and participating in the informed consent process.
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If you're an experienced clinician looking to forge a new career path where your clinical knowledge is valued, consider our Utilization Review Specialist position. As a Utilization Review Specialist, you will play a pivotal role in ensuring the efficient and effective utilization of healthcare resources.
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Provides ad-hoc programming support to Clinical Operations, Data Management, Statistical Programming, Biostatistics, Drug Safety, Clinical Science, Medical Writing and Drug Safety to ensure rapid access to clinical study data for data cleaning/validation, SAS listings review, TLF, dry runs, etc.
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The Utilization Review Specialist manages daily operations, which include supervising the staff performing benefit enrollments and utilization management activities. The Utilization Review Specialist participates in department development and unit performance improvement.
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We seek attorneys to assist with document review, privilege review, expert testimony, legal research, and foreign language translation. Experience with electronic document review technology Examples: Relativity, Concordance, ViewPoint, etc.
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review job Title: associate clinical research Company: Children's Hospitals And Clinics Of Minnesota
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