Reviewer Appeals and Hearings to coordinate and perform all appeal related duties including analyzing and responding... in our mission Reviews provider appeals and redeterminations using approved clinical and coding guidelines and documents appeal...
Reviewer Appeals and Hearings to coordinate and perform all appeal related duties including analyzing and responding... in our mission Reviews provider appeals and redeterminations using approved clinical and coding guidelines and documents appeal...
OR Graduate of an accredited School of Nursing. Work Experience: Two years of clinical experience as an RN. Skills...Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established...
Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established... criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines...
sets or clinical guidelines. Provides support and review of medical claims and utilization practices..., and appeals. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical...
Professional (CICP) required or: CCDS Certified Clinical Documentation Specialist required or: RN - Registered Nurse - State... reviews of MS-DRG and APR-DRG coding and clinical documentation to ensure the accuracy of DRG assignment and reimbursement...
Responsibilities Primary Job Responsibilities: Obtain clinical, functional, and psychosocial information from the... medical records on site, through remote electronic access, telephonically or by fax in a collaborative effort...
in the clinical eligibility and nurse reviewer processes. Maintain confidentiality of all business documents...Overview: Job Summary Under the general direction of the Associate Director, or designee, the Clinical Coordinator...
in the clinical eligibility and nurse reviewer processes. Maintain confidentiality of all business documents...Overview: Job Summary Under the general direction of the Associate Director, or designee, the Clinical Coordinator...
Company, is hiring UM RN Appeals Coordinator to join our remote team! Claims Processors are responsible for the accurate..., patients and families, clinical personnel, support staff, outside agencies, and community partners Qualifications RN...
of Quantum Health's employer groups. The nurse is responsible for acquiring all clinical documentation to appropriately process... to achieve proper clinical decisions when performing clinical reviews. The role requires use of multiple systems, acquisition...
Director of Quality Assurance Desired Skills & Qualifications MUST have a Clinical degree(examples: RN, PT, ST, OT) and 5... our Kobico BCC Team, and is currently looking for a PRN (10-20 hours per week) Home Care Coder and Oasis reviewer. If you value...
Overview: GENERAL SUMMARY: Under the general supervision of the Associate Director, or designee, the Nurse Reviewer... II is responsible for completing in-person assessments and reviewing medical records to determine clinical eligibility...
. Create and maintain training documentation. Collaborate on remediation plans for employees. Provide reviewer training when..., monthly). Other duties & special projects, as assigned and based on business needs. Requirements: Qualifications: RN...
Overview: Job Summary Under the general supervision of the Associate Director, Clinical Coordinator, or designee..., the Nurse Reviewer II is responsible for providing administrative case management as part of the Community Case Management...
optimal health outcomes. Our Investment in You: Full-time remote work Competitive salaries Excellent benefits Key... cases to Physician Reviewer when the treatment request does not meet medical necessity per guidelines, or when guidelines...
). Experience abstracting procedure targeted cases SCR (Surgical Clinical Reviewer) Certification Surgical nursing background...-based care. In fact, medical record abstraction is the preferred data collection method for clinical research, quality...