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.
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...Job Type Full-time Description Charter Cabin Attendant (Flight Attendant) Ventura Air Services About Ventura Air Services... ...they touch down, they have the power to define the entire experience. They are the face of our company, our eyes and ears in the...
...premier shopping and dining neighborhood of Boston's Back Bay is an iconic property originally opened in 1927 as one of the first Ritz-Carlton hotels in the U.S. and most recently was the Taj Boston. The building was recently transformed into a 286-room luxury hotel with...
...gun range, hiking, horse riding, and more. Role overviewThis position reports to Clark State Forest and serves as the heavy equipment operator for six state forests and a tree nursery located in southern Indiana. The position requires Class A CDL and experience operating...