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Prime Therapeutics
Overview
This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, often interacting with requesting physicians and providers. Responsibilities include discussing determinations, providing clinical rationale for appeals, and ensuring documentation accuracy according to established guidelines.
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Compensation
$91 - $154 / HOUR
Posted
8 days ago
This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, requiring interaction with physicians and providers to discuss determinations and provide clinical rationale for appeals. The reviewer also assists in maintaining consistency by utilizing clinical review guidelines and participating in training and research activities related to utilization management.
This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, often interacting with physicians and management staff. Responsibilities include discussing determinations with requesting providers and providing clinical rationale for standard and expedited appeals.
The Physician Clinical Reviewer provides timely medical review of service requests that do not meet initial medical necessity guidelines, routinely interacting with physicians and staff. Responsibilities include discussing determinations with requesting providers, providing clinical rationale for appeals, and ensuring consistency using medical review guidelines.
Fairview Health Services
The Physician Assistant serves as the clinical coordinator for triaging interfacility transfers and direct admissions across the Fairview system, assessing clinical appropriateness and determining optimal patient destinations based on acuity and capacity. This role involves collaborating with various placement specialists and providers to ensure seamless patient flow and efficient resource utilization across nine metro hospitals.
Salary not listed
3 months ago
