development and implementation of clinical protocols, quality improvement, utilization management, and regulatory compliance... and outcomes. Oversee utilization management activities, review and approve medical necessity for treatments, and facilitate...
/management expertise Expanded credentials as an expert in Independent Medical Exams and physician advisor services Fully... for providers throughout the state of Oregon. Requirements As Physician Reviewer/Advisor, you will utilize clinical expertise...
/management expertise Expanded credentials as an expert in Independent Medical Exams and physician advisor services Fully... for providers throughout the state of Alaska. Requirements As Physician Reviewer/Advisor, you will utilize clinical expertise...
for providers throughout the state of California. Requirements As Physician Reviewer/Advisor, you will utilize clinical... practice with medical necessity and utilization review/management expertise Expanded credentials as an expert in Independent...
. We are searching for providers throughout the state of Washington. Requirements: As Physician Reviewer/Advisor, you will utilize... practice with medical necessity and utilization review/management expertise Expanded credentials as an expert in Independent...
with the requirement that the physician advisor shall not have a financial conflict of interest -Must present evidence...Overview: Are you an accomplished Board Certified Physical Medicine & Rehabilitation physician? Are you passionate...
. We are searching for providers throughout the state of California. Requirements: As Physician Reviewer/Advisor, you will utilize... practice with medical necessity and utilization review/management expertise Expanded credentials as an expert in Independent...
. We are searching for providers throughout the state of Alaska. Requirements: As Physician Reviewer/Advisor, you will utilize... practice with medical necessity and utilization review/management expertise Expanded credentials as an expert in Independent...
. We are searching for providers throughout the state of Oregon. Requirements: As Physician Reviewer/Advisor, you will utilize... practice with medical necessity and utilization review/management expertise Expanded credentials as an expert in Independent...
, clinical utilization management and the transition to the next appropriate level of care. Responsibilities Essential... to: Accurate medical necessity screening and submission for Physician Advisor review Care coordination that includes admitting...
with the attending physician, department management, physician advisor, and insurance companies to assure the justification... Integrated Nursing Case Manager, under the direction of the Director/Manager of Case Management, provides care/service safely...
, clinical utilization management and the transition to the next appropriate level of care. Responsibilities: Essential... to: Accurate medical necessity screening and submission for Physician Advisor review Care coordination that includes admitting...
that primarily supports the Aetna Better Health Plan of Oklahoma. This UM (Utilization Management) Medical Director will be a "Work... request. This position is primarily responsible for Utilization Management, including prior authorization as well...
and submission for Physician Advisor review, Care coordination & Transition planning assessment and reassessment Implementation... patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources...
benefit review/ utilization review and processing the independent physician review request for individuals under the group... Benefit Review process. Staffs medically complex cases with the Supervisor/Manager, Case Management. Accurate utilization...
appropriate for secondary review to Case Management Department leadership, the Medical Director, or Physician Advisor.... Resource Management; Assures prudent utilization of all resources (fiscal, human, environmental, equipment and services...
in Internal Medicine strongly preferred. Utilization Management or Appeals experience preferred. For candidates working... programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor...
, clinical utilization management and the transition to the next appropriate level of care. Responsibilities Essential... to: Accurate medical necessity screening and submission for Physician Advisor review Care coordination that includes admitting...
and Oncology strongly preferred. Utilization Management or Appeals experience preferred. For candidates working in person..., cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical...
. Utilization Management or Appeals experience preferred. For candidates working in person or virtually in the below locations..., cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical...