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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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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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Department: Operating Room Schedule/Status: 8am-5pm; Full Time Standard Hours/Week: 40 Location: Titusville General Description: Under the supervision of the Operating Room Manager, the RN Clinical Review and Reconciliation Specialist will maintain charge reconciliation processes that ensure revenue capture and billing within regulatory and compliance guidelines.
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Other: Successful completion of an educational program in Nuclear Medicine accredited by the Joint Review Committee on Educational Programs in Nuclear Medicine Technology or the Canadian Association of Medical Radiation Technologists (CAMRT) OR Successful completion of an educational program in Radiography accredited by the Joint Review Committee on Education in Radiologic Technology.
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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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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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The Utilization Review Nurse will use appropriate governmental policies as well as specified clinical guidelines/ criteria to guide medical necessity reviews and will use effective relationship management, coordination of services, resource management, education, patient advocacy and related interventions to identify gaps in billing and coding between claims and authorizations, ensure members receive appropriate levels of care, while promoting cost effective medical outcomes.
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Utilization Review Nurse Full Time Days at Trinity Health in Nampa, Idaho, United States Job Description Employment Type: Full time Shift: Day Shift Description: At Saint Alphonsus Health System, we are looking for people who are living out their calling.
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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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Plan, direct and coordinate QC batch record review, logbook review, QC test review, and lot disposition activities. Review calibration, monitor and evaluate systems and equipment (i.e. water systems, environmental chambers, analytical instrument/equipment.
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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 Loan Review Manager role provides leadership to our people and clients to deliver Crowe's loan review and credit consulting services, including outsourced and co-sourced loan review, staff augmentation, credit consulting, and credit remediation.
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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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Experience as a member of a document review team. Familiarity with document review workflows. Examples: Privilege/Responsiveness Review, Redactions, Conceptual Searching, First and Second Review, etc.
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VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Manhattan, New York. 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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review job Title: clinical licensed social worker Company: Sutter Health
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