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InboxDollars is the fun rewards club that pays you real cash for the everyday things you do online.
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The Medical Coder Position will administer and process all incoming medical records and lay evidence included with a proposal to ensure correct documents are provided to the WCMSA reviewer. - Succinctly summarize the facts for each case for the reviewer indicating what medical evidence is present supporting the set-aside proposal.
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$103,409 - $167,336 a yearTemporaryExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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As a Physician Clinical Reviewer you will be a key member of the utilization management team. Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
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Physician Clinical Reviewer, MRx - Oncology - REMOTE. Reviews all cases in which clinical determinations cannot be made by the Initial Clinical Reviewer. On a requested basis, may function as Medical Director for select health plans or regions, assuming overall accountability for utilization management while working in conjunction with the VP, Medical Affairs.
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Support proposals as an author and reviewer, to include being a presenter in proposals requiring an oral presentation. Experience developing solutions and strategic roadmaps (current and target/future state) for broad spectrum of technical areas such as SAP, Elastic, Splunk, Jenkins, webMethods, AWS and Azure Cloud and others.
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Refers cases requiring clinical review to a Nurse reviewer. Refers cases requiring clinical review to a Nurse reviewer. The Utilization Management Representative I will be responsible for coordinating cases for precertification and prior authorization review.
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Part Time Utilization Reviewer RN at St. Luke's Health System in Boise, Idaho, United States Job Description Overview St. Luke's Health System in Boise is seeking an Utilization Reviewer RN to join our team.
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Act as subject matter expert for Pharmacy Customer Data (PCD) team to build additional capabilities within existing applications (e.g. Quickbase, CSMS DDR [Due Diligence “Customer Reviewer”], etc.
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Strong publication record, including as a lead author or reviewer, in top-tier journals or conferences. PhD Computer Science, Mathematics, Statistics, Physics, Linguistics or a related field with a dissertation, thesis or final project centered in Machine Learning and Deep Learning) with 3+ years relevant experience is preferred but not a must; OR.
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Quality Clinical Reviewer. LCSW - Licensed Clinical Social Worker - Care Mgmt, LMHC - Licensed Mental Health Counselor - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, MFT - Marriage and Family Therapist - Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt.
$64,285 - $102,855 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists. Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.
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As an independent peer reviewer, provide project document quality control, review for sufficiency, technical accuracy and compliance with ITD procedures and state and federal regulatory requirements.
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