Can work remotely in any state except CA, NY, HI or AK
20 - 40 hours/week and possible weekend coverage (in a rotation)
Summary:
Evaluates clinical service requests made by an organization's members and providers. Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests.
May also provide clinical leadership in other areas of the organization.
Identifies opportunities to manage members' clinical situations with a view toward creative problem solving and anticipation of possible future clinical problems for the member.
Participates in the process to evaluate clinical service requests.
Participates in the Physician Review Units' appeal process of service denials. Participates in the development of Physician Review Units' policies and procedures. Actively participates in all unit continuous quality improvement activities.
Other duties as assigned by the Medical Director. Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine requested and 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background.
Must have understanding of managed care and demonstrate PC proficiency, as file review will be done via computer in most cases.
(Note: Position does not provide direct patient care or medical diagnosis.)
Food Runners/Bussers Our Food Runners and Bussers are an integral part of our front of house service team providing exceptional hospitality, serving delicious scratch-made food and drink, and help keep our restaurant environment clean and welcoming.Hourly Pay: $18+...
...Police Officer Juneau Police Department Committed to Service and Excellence $30,000 Hiring Bonus for eligible applicants; inquire... ...without any administrative, mental, or disciplinary hindrance. Retired or former Police Officers (before retirement/separation), must...
...Dane Street, a nationally recognized Independent Review Organization (IRO), is expanding its panel of Physician Reviewers. We are currently seeking Board-Certified... ...to conduct Utilization Reviews. This is a fully remote, non-clinical role offering supplemental income...
...all applicable post orders and reporting requirements. Minimum Requirements: A concealed carry weapons permit is required. Retired or Current Law enforcement or retired corrections is required. An armed guard card/license is required. A valid drivers...
...Must be a Current or Retired Police Officer. 2nd and 3rd shifts available.Urgent Hiring: Highly Skilled OffDuty Police OfficerDo you thrive in a dynamic, supportive environment where your skills can truly shine? Are you looking for a role that allows you to make a...