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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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Qualifications Masters Degree preferred; minimum Bachelors Degree in Psychology or related Human Service Field or RN. Knowledge of Utilization Review Processes, insurance plans, mental health and chemical dependency treatment.
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Experience in first-line underwriting and second-line credit risk management/ adjudication or loan review is required. The Credit Risk Review (“CRR”) team fulfills the responsibilities of the Credit Review (or Loan Review) function of Lendistry, consistent with the May 2020 Interagency Guidance on Credit Risk Review Systems.
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Remote Utilization Review Nurse (for LTSS services) (RN). Requirements : Active RN in NY (LTSS / MLTC experience conducting reviews using CMS guidleines) Remote Utilization Review Nurse (for LTSS services) (RN.
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Utilization RN - Utilization Review RN - Travel Utilization Review RN, Part-Time, Contract, Travel, Temporary, 13 Weeks, Temp. Tier5, Travel Utilization Review RN Registered Nurse.
$9,369.44 a monthExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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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.
$56,181 - $68,034Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred. Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility.
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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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Enforce City of Atlanta Stream Bank Buffer requirements, review for and enforce State of Georgia Stream Bank Buffer requirements, coordinate with other agencies as necessary, e.g. Georgia Department of Natural Resources, Georgia Soil and Water Conservation District.
$56,614 - $75,451 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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If applicable, answers donor recovery screening questions as needed on an on-call basis on behalf of the DCIDS Tissue Bank Assists in training and mentoring of new Quality Review Coordinators. As needed, meets with the DCIDS Tissue Bank Medical Director(s) to review, and answer questions pertaining to the information and documentation within the donor record.
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The Quality Review Coordinator performs ocular and tissue donor record quality assurance review in compliance with DCIDS, FDA, EBAA, and AATB policies, procedures, regulations, and standards.
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Arizona State University Fire Inspector EHS Fire Safety Campus: Tempe 102651BR Job Description Provides Fire Safety compliance in the forms of existing building inspections, special event plan review and permitting, construction plans review and permitting.
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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.
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The Utilization Review Specialist will also coordinate with appropriate discharge planning processes, providing feedback on documentation processes; and functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.
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Experience with electronic document review technologyExamples: Relativity, Concordance, ViewPoint, etc. Familiarity with document review workflowsExamples: Privilege/Responsiveness Review, Redactions, Conceptual Searching, First and Second Review, etc.
$150ExpandApply NowActive JobUpdated Today
review job Title: manager clinical rn Company: Humana
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