Performs training and provides subject matter expertise on clinical reviews needed to resolve and process appeals to team members. • Reviews medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and
Position Title:Medical Management Specialist I/ PHRN Shift: Job Description: Responsible for providing non-clinical support to the Medical Management and/or Operations areas. Primary duties may include, but are not limited to: Gathers clinical information regarding case and
Company Description About Sutherland Artificial Intelligence. Automation. Cloud engineering. Advanced analytics. For business leaders, these are key factors of success. For us, they’re our core expertise. We work with iconic brands worldwide. We bring them a
We are looking for a USRN Utilization Review Specialist responsible for reviewing clinical information, medical records, and patient cases to determine the medical necessity, appropriateness, and level of care based on established clinical guidelines and payer requirements. The
Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. Roles and
Performs training and provides subject matter expertise on clinical reviews needed to resolve and process appeals to team members. • Reviews medical records and clinical data to determine medical necessity for services in accordance with policies,
The Clinical Consultant provides clinical and operational support as a U.S. Healthcare Subject Matter Expert, providing various clinical support services and operational guidance for business processes, to include Case Management, Utilization Management, Clinical Coverage Preservice, Claims and
Work setup: ONSITE / BGC, Taguig within 6 months then transfer to Bridgetowne, QC Work schedule: Nightshift The Team Lead – Clinical Denials provides operational and clinical leadership to a team of Clinical Denials Specialists supporting
Work setup: ONSITE / BGC, Taguig within 6 months then transfer to Bridgetowne, QC Work schedule: Nightshift The QA – Clinical Denials is responsible for conducting quality audits of clinical denial reviews, appeal preparation, documentation, coding validation,
Work setup: ONSITE / BGC, Taguig within 6 months then transfer to Bridgetowne, QC Work schedule: Nightshift The QA Team Lead – Clinical Denials provides day-to-day leadership and oversight for the quality assurance function supporting Clinical
Work setup: ONSITE / BGC, Taguig within 6 months then transfer to Bridgetowne, QC Work schedule: Nightshift The Program Manager – Clinical Denials provides strategic and operational leadership for one or more clinical denials programs across
Work ScheduleStandard (Mon-Fri) Environmental ConditionsOffice Job Description Join Us as a Lead Medical Project Coordinator At Thermo Fisher Scientific, you’ll discover meaningful work that makes a positive impact on a global scale. Join our colleagues in
WHY JOIN US? The Company Nurse (Occupational Health Nurse) is responsible for promoting and maintaining the health, safety, and well-being of employees by delivering quality occupational health services, administering first aid and emergency care, managing the