Average salary: $73,567 /yearly
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...coding staff to ensure contractual compliance. Reports to the Manager, Retrospective UM. Supervises staff who conduct retrospective review of medical claims for appropriate DRG or non-DR coding and processing. Performs independent research and in-depth evaluation of...
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...ensure better access to our unique model of care.
Overview:
Phoenix Medical Psychiatric Hospital is looking for a Utilization Review Coordinator to coordinate patients services across the continuum of care by promoting effective utilization, monitoring health...
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...owned community bank and one of Prairie Business Magazine's 50 best places to work for 10 years running. We are looking for a Credit Review Associate who can clearly identify borrower risk and translate the risk factors into terms others can understand within a narrative...
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...Role: Penalty Review Specialist-1276
Estimated Duration: 6+ months
Location: Phoenix, AZ (hybrid)
Position Description
Primary Duties:
Analyze applicant data for abatement consideration.
Request additional information when needed....
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...well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Clinical Review Pharmacist
The Clinical Staff Pharmacist is responsible for the processing and documenting of Utilization Management requests...
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...Role: Purchase Reviewer-1153
Estimated Duration: 6+ months
Location: Phoenix, AZ
Position Description
The purpose of this position is to provide support to constituents, including education administrators and staff, community members, education partners...
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...members, Valenz engages early and often for smarter, better, faster healthcare. About our Opportunity:
As the Clinical and Bill Review Advisor at Valenz Health, you will play a pivotal role in guiding and advising on our internal clinical and bill review processes....
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...Health Medical Center
Department: Care Management
Schedule: Regular FT 36 Hours Per Week
Shifts: Mid
As a Valleywise Utilization Review RN Coordinator, you are part of a multidisciplinary team providing exceptional care to our patients. As a Utilization Review RN...
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...our business.
Join Evolent for the mission. Stay for the culture.
**What You'll Be Doing:**
As a Oncology, Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives...
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...do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Physician Clinical Reviewer- GI – REMOTE
Summary
Key member of the utilization management team, and provides timely medical review of service requests...
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...Experienced Document Review Attorney – Remote
Great opportunity for l icensed attorneys with document review experience interested in quality focused e-Discovery. We have some projects anticipated to start soon and others in the pipeline. Please apply to get on...
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...appropriate medical team to promote quality and cost effectiveness of medical care.
+ Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria
+...
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...according to protocol and that all documentation is timely and meets all Federal and State requirements.
+ Ensure second-level reviews have been performed and documented and may confer with medical directors, Health Plan Manager(s), Inpatient Care Coordinators (ICC’...
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...required
Bachelor’s degree in nursing preferred
Minimum three (3) years of clinical nursing and/or Care Management experience is required
Orthopedic experience required.
Clinical review, utilization review, or quality assurance review experience preferred...
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...Custard Insurance Adjusters, Inc.
Property Claims Reviewer/QA
Phoenix, AZ
We are growing our company and looking for highly skilled team members to grow with us! We are looking for motivated individuals who are passionate about quality work and providing superior...
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...Job Description
Job Description
General Purpose
To review and bill Loss Control Inspections and ensure they meet Afirm/Davies quality control standards, customer specific requirements, and industry standards.
Essential Duties and Responsibilities:
~ Reviews...
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...abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.
At IntegrityM, we offer a culture of opportunity, recognition, collaboration, compassion and supporting our community. We thrive...
Full time
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...Job Description
Job Description Summary:
The Registered Nurse will utilize standard criteria to review post-service and prepayment reviews of Outpatient Behavioral Health claims. The nurse will utilize HCPC Codes to ensure claims are being charted for correct processing...
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...statutes, rules, and compliance with policies and procedures.
The primary duties for this position include the following:
Review account expenses and complete account closures
Conduct audits on randomly selected accounts to assess program compliance...
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Overview:
KYC REVIEW ANALYST- OPS
WHAT IS THE OPPORTUNITY?
Conduct Enhanced Due Diligence background investigations for commercial loan borrowers in adherence with credit policy and compliance with BSA and USA Patriot Act. Responsible for the quality assurance...
Hourly pay
Full time
