for Kimberly-Clark. For a complete overview, see . Great support for good health with medical, dental, and vision coverage... health nurse, and allowances for high-quality safety equipment. Flexible Savings and spending accounts to maximize health...
critical medical review operations by ensuring accurate, compliant documentation for a leading US healthcare services... of opportunities for me.' - Underwriting Assistant, ASW Philippines What You'll Do Review and verify medical reports for completeness...
Strong clinical knowledge, particularly in: Medical necessity review Interpretation of clinical documentation Understanding...Requirement : Registered Nurse (PHRN/USRN) Minimum 1 year of experience using InterQual criteria At least 2 years...
Grievance & Appeals Creates complete appeal records for external appeal reviews, using standardized Independent Review...'s Grievance Team and client Medical Directors. Completes assignments within client-designated turnaround times. Priority Skill...
patient needs, coordinating care, supervising staff, and maintaining compliance with regulations. What You'll Do: Review... education on medications, treatments, and care procedures Maintain accurate medical records and oversee proper documentation...
An Occupational Health Nurse (OHN) plays a pivotal role in fostering a safe and healthy workplace by addressing... With critical medical thinking skills and good bedside manner Provide basic health care administering first aid...
and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility... be required to gather additional information that may be needed. Other staff responsibilities may be review and analysis of post service...
Job Location: Clark Outsourcing - Building 35 Philexcel Business Park, Clark Pampanga Quick Rundown: The Medical Scheduler plays... Assist with client documentation, data entry, and filing of medical or administrative records. Run reports, maintain tracking...
guidelines. Completes review of pended claims post-service for either Medical Necessity or Contractual Reviews. SKILL..., medical policy, and member eligibility, benefits, and contracts. Service requests may be from inbound calls and facsimile...
Founded In 2020, Lavender Is The Largest Nurse-owned And Operated Online Psychiatry And Therapy Office In The United..., efficiently, and with care. workspace As a key connector between pharmacies, laboratories, clients, and Nurse Practitioners, the...
complete appeal records for external appeal reviews, using standardized Independent Review Entity (IRE) forms and including... geographic region. Presents verbal and written case summaries to client's Grievance Team and client Medical Directors. Completes...
LOB Description Medical Necessity Review for Appeals (Claims denied due to medical necessity) Job Summary The... Registered Nurse (Active License) Minimum 1 year in a Manager role Work Experience Experience in managing teams handling Clinical...
to reconcile medications, review discharge instructions, and schedule follow-up appointments with PCPs. ● Red Flag Monitoring.... Care Planning & Assessment ● Comprehensive Assessment: Conduct telephonic clinical assessments to gather data on medical...
Ability to work in a fast paced and production environment Review denied insurance claims Review patients' medical files... of your dependents covered for FREE Group Life Insurance Medical Cash Allowance Rice Allowance Clothing Allowance Holiday Gift...
Grievance & Appeals Creates complete appeal records for external appeal reviews, using standardized Independent Review...'s Grievance Team and client Medical Directors. Completes assignments within client-designated turnaround times. #LI-PH Priority...
Grievance & Appeals Creates complete appeal records for external appeal reviews, using standardized Independent Review...'s Grievance Team and client Medical Directors. Completes assignments within client-designated turnaround times. Bachelor...
LOB Description Medical Necessity Review for Appeals (Claims denied due to medical necessity) Job Summary The... Registered Nurse (Active License) Minimum 1 year in a Manager role Work Experience Experience in managing teams handling Clinical...
-functional teams to ensure compliance with medical policies and optimizing the resolution of clinical denials. Ongoing training... in Communication to effectively collaborate, explain denials, and provide guidance on medical policy-related matters. Knowledge...
of Business Overview: Utilisation Management - focused on medical necessity approvals and denials for pre-service, retrospective... regulations. Qualifications: Bachelor's Degree in Nursing with an active and valid US Registered Nurse (USRN) license. At least 1...
UM request for services against established clinical review criteria, referring cases not meeting criteria to a physician... reviewer or prescribed escalation protocol. Coordinates physician reviewer or MDS/Facility - Nurse Practitioner...