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The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed. Three to Five (5) years experience in Case Management/Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, Case Manager, or Utilization Review Coordinator.
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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 Clinical 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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Utilization Review Specialist | Highland Hospital | Charleston, West Virginia. Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization review information; Educates hospital staff about requirements and trends.
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Experienced Document Review Attorney – Remote Great opportunity for licensed attorneys with significant document review experience interested in quality focused eDiscovery. JOB DETAILS Project-based eDiscovery document review (litigation and/or investigation) Fully remote work environment.
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Must have at least eighteen months’ worth of document review experience (preferably on the Relativity platform) during the last two years. Must have at least eighteen months’ worth of document review experience (preferably on the Relativity platform) during the last two years.
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Review aging accounts receivable with Project Controls Specialist and Operation Manager to determine who will follow up with clients for payment status. Meet with Project Controls Specialist and Operation Manager to review, discuss, and resolve issues with invoicing and documentation provided.
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The Utilization Review Specialist is responsible for using clinical best practice knowledge and skilled intervention to determine patient level of care and provide concurrent review with insurance payers in order to achieve quality outcomes and ensure appropriate reimbursement.
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Participate in the annualHEDIS andQARR hybrid medical record review project:Work with provider offices to facilitate request and review of charts Supports temporary staff in the review of medical records (electronic and paper-based) Serve as a final reviewer of HEDIS and QARR records Other duties as assigned by Quality Review Lead or QM Operations Director.
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Experienced Document Review Attorney – Remote. Project-based eDiscovery document review (litigation and/or investigation) Great opportunity for licensed attorneys with significant document review experience interested in quality focused eDiscovery.
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Three colleges, two world-class medical institutions, the La Crosse Symphony Orchestra, a restored nineteenth century downtown business district, and a number of galleries and art centers have made La Crosse a regional center for culture, entertainment, medical care, shopping, sports and recreation.
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Review Project with Controller & Project Accountant - Project Duration, Scope, Heavy Job Reporting Format, Davis-Bacon Wages, Per Diem needs, Billing Cycle, Project Budget, Profit Goals & Project Risks - Can be handled during turn over meeting.
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Three to Five (5) years experience in Case Management/Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, or Utilization Review Coordinator). Utilization Review Specialist/Behavioral Health Substance Abuse.
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Experience with Veeva Promomats, Aprimo, Asana, Zinc, JIRA and Adobe Experience Manager or other promotional review software and marketing project management tools a plusStrong written and verbal communication skills, ability to organize, prioritize and meet deadlinesStrong planning, organizational, and project support skillsProofreading and editing skillsStrong communication skills, both written and oral.
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Inform team members of denials and potential denials so appropriate action can be taken by Utilization Review nurse. Contact Utilization Review nurse when reviews are not documented. Maintains daily contact with Utilization Review Specialist, Denial Specialist Nurse, Utilization Management Team Leader, and Patient Access 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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review job Title: call center representative Company: Gentech Murtech
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