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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.
This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, requiring routine interaction with physicians and management staff. Responsibilities include discussing determinations with requesting providers within regulatory timeframes and providing clinical rationale for standard and expedited appeals.
The Physician Clinical Reviewer provides timely medical review of service requests that do not initially meet medical necessity guidelines, interacting with providers and staff as needed. Responsibilities include reviewing complex cases, discussing determinations with requesting physicians, providing clinical rationale for appeals, and ensuring compliance with various guidelines and policies.
Best Home Health Providers, Inc.
The role focuses on reviewing OASIS assessments for compliance and ensuring accurate ICD-10 coding for home health patients. The nurse will collaborate with clinical staff to resolve data integrity issues and participate in quality improvement initiatives.
$110 - $130 / HOUR
24 days ago
The role involves reviewing OASIS assessments for compliance and ensuring accurate ICD-10 coding for patients. The nurse will collaborate with clinical staff to resolve data integrity issues and participate in quality improvement initiatives.
Premier Home Health Providers Inc.
The role involves reviewing OASIS assessments for compliance and ensuring accurate ICD-10 coding for home health patients. The nurse will collaborate with clinical staff to resolve documentation issues and participate in quality improvement initiatives.
27 days ago
