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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 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.
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 discussing determinations with requesting physicians, providing clinical rationale for appeals, and ensuring documentation accuracy according to established guidelines.
3 months ago
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 assisting Initial Clinical Reviewers.
