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Carle HealthNew
Overview
Performs inpatient chart reviews to ensure accurate DRG assignment and clinical documentation that reflects patient severity and risk of mortality. Coordinates with multidisciplinary teams to identify diagnoses and manages the appeal process for DRG denials.
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Compensation
Salary not listed
Posted
New
MRIoANew
The role involves conducting independent Utilization Reviews for oncology cases. It requires adherence to HIPAA regulations and company policies regarding sensitive health information.
Conduct independent Utilization Reviews as a Board-Certified physician in Rheumatology. The role requires adherence to HIPAA regulations and company policies regarding sensitive health information.
Palm Medical Centers
The role involves reviewing medical referrals to determine medical necessity and ensure compliance with CMS guidelines. It requires collaborating with healthcare providers and documenting findings to facilitate coordinated patient care.
3 days ago
Prime Therapeutics
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.
$91 - $154 / HOUR
8 days ago
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.
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.
Empower AI Inc.
Perform comprehensive medical record and claims reviews to make payment determinations for Medicare Diagnosis Related Group (DRG) claims. Utilize coding principles and electronic databases to ensure departmental compliance with quality management systems.
12 days ago
CVS Health
Responsible for assessing, planning, and coordinating case management activities through telephonic and face-to-face visits to improve member wellness. Manages a caseload of supportive and medically complex members, coordinating services such as prior authorizations and medication reviews.
$21 - $41 / HOUR
22 days ago
Federal Hearings And Appeals
The Physician Peer Reviewer is responsible for reviewing medical case files and making medical determinations regarding medical necessity and appropriateness. This includes analyzing Federal and State laws, regulations, and applicable policy guides.
25 days ago
Managed Medical Review Organization
The Physiatrist will conduct comprehensive and objective medical chart reviews and produce determinations that are clear and well-supported by evidence. They must communicate findings professionally and complete reviews within specified deadlines.
Conduct comprehensive and objective medical chart reviews and produce clear, evidence-supported determinations. Communicate findings professionally and complete reviews within specified deadlines.
Perform comprehensive medical record and claims reviews to make payment determinations for Medicare Diagnosis Related Group (DRG) claims. Utilize coding principles and electronic databases to ensure departmental compliance with quality and ISO standards.
28 days ago
Perform comprehensive medical record and claims reviews to make payment determinations for Medicare Durable Medical Equipment. Utilize coding principles and electronic databases to ensure compliance with quality and production standards.
Perform comprehensive medical record and claims reviews to make payment determinations for Medicare Part A services. Utilize coding principles and electronic databases to ensure departmental compliance with quality and ISO standards.
MRIoA
Conduct independent utilization reviews and clinical medical reviews. Perform peer-to-peer conversations during daytime hours.
1 month ago
Conduct independent utilization reviews for medical cases. Perform peer-to-peer conversations during daytime hours to evaluate clinical necessity.
VENESCO, LLC
The Pharmacovigilance Physician provides medical oversight of drug safety data and supports risk management strategies. Key duties include conducting medical reviews of adverse events and contributing to regulatory safety submissions and reports.
Saving-Sight
The Medical Review Coordinator evaluates donors' medical and social histories to determine eligibility for transplantation. Responsibilities include documenting medical information and collaborating with hospital staff and physicians.
San Gabriel/Pomona Regional Center
Provides nursing coordination, consultation, and assessments for individuals with intellectual and developmental disabilities. Responsibilities include conducting evaluation visits, monitoring facility compliance, and coordinating medical care with providers and families.
$76,544 - $131,373 / YEAR
