Medical Necessity Reviewer

About the Role:Piedmont Healthcare Corporate is seeking a skilled Clinical Appeals Specialist to join our team. As a key member of our appeals process, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key Responsibilities:Conduct detailed...

Job SummaryPiedmont Healthcare Corporate is seeking a skilled Clinical Appeals Specialist to join our team. As a key member of our appeals process, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key ResponsibilitiesConduct detailed reviews of...

About the RoleAs a Utilization Review Nurse at Sidecar Health, you will play a critical role in evaluating the medical necessity and quality of healthcare services for our members. This involves reviewing medical records, ensuring compliance with established clinical guidelines and policies, and collaborating with healthcare providers to gather additional...

Job Description:The Clinical Review Specialist role at Sonder Health Plans is to ensure that healthcare services are administered with quality, cost efficiency, and within compliance.By continuously reviewing and auditing member treatment records, the Clinical Review Specialist will ensure members do not receive unnecessary procedures, ineffective treatment,...

Job Description:The Utilization Review Nurse's role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing member treatment records, the utilization review nurse will ensure members do not receive unnecessary procedures, ineffective treatment, or experience...

Job Title: HEDIS Nurse Abstractor SpecialistJob Summary:Spectraforce Technologies is seeking a highly skilled HEDIS Nurse Abstractor Specialist to join our team. As a HEDIS Nurse Abstractor Specialist, you will be responsible for reviewing medical records, abstracting pertinent data, and entering it into a specified database to support HEDIS reporting.Key...

Hours: 20-30 hours/week Contract: 06 months contract Objective In this position, you will oversee and facilitate projects, offer medical insights on both branded and unbranded materials, and engage in various initiatives. You will act as a representative of medical affairs in the Medical, Legal, and Regulatory (MLR) review process to guarantee...

Job SummaryAs a Nurse Investigator with the Georgia Department of Law, you will play a critical role in uncovering and preventing healthcare fraud within the Medicaid program. Under the direction of the Fraud Unit Director, you will assist in conducting thorough investigations by reviewing provider and recipient records, making determinations of medical...

Job SummaryWe are seeking a highly skilled and experienced Prior Authorization Specialist to join our team at a busy and complex oncology medical practice. The ideal candidate will have a strong background in medical insurance verification and authorization, with a minimum of 1-2 years of experience in an oncology setting.Key Responsibilities:Obtain...

Clinical Review Nurse I - Medicare Part ANational Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.Location:This is a virtual position and preferred candidates reside within 50 miles...

Job Summary:Spectraforce Technologies Inc is seeking a highly skilled Quality Assurance Nurse Reviewer to join our team. As a Quality Assurance Nurse Reviewer, you will play a critical role in ensuring the accuracy and quality of medical records data.Key Responsibilities:Conduct quality assurance reviews of medical records to validate abstracted data and...

Job SummaryWe are seeking a highly skilled and experienced Prior Authorization Specialist to join our Medical Practice team. As a Prior Authorization Specialist, you will play a critical role in ensuring that our patients receive the necessary coverage for their chemotherapy treatments.ResponsibilitiesObtain insurance authorization and pre-certification for...

Job Title:Clinical PharmacistJob Location:RemoteTop 3/5 Skills:PharmacistMedicareHealthcare experienceJob Duties:Duties:This role will be completely remote - candidates can be sourced from across the US as long as they're able to support the CST schedule.Candidates must have a quiet and private working environment and have a reliable, high-speed internet...

Job SummaryWe are seeking a highly skilled and experienced Nurse Medical Management Senior to join our team at Elevance Health. As a key member of our medical management team, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.Key ResponsibilitiesTeam Leadership: Lead a team of nursing staff in providing...

Job SummaryWe are seeking a highly skilled and experienced Prior Authorization Specialist to join our Medical Practice team. As a Prior Authorization Specialist, you will play a critical role in ensuring that our patients receive the necessary coverage for their chemotherapy treatments.ResponsibilitiesObtain insurance authorization and pre-certification for...

Job Summary:Piedmont is seeking a highly skilled Clinical Appeals Specialist to join our team. As a Clinical Appeals Specialist, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key Responsibilities:Conduct detailed reviews of patient medical...

Job SummaryAs a Nurse Investigator with the State of Georgia, you will play a critical role in ensuring the integrity of our healthcare services. Under the direction of the Fraud Unit Director, you will assist in healthcare investigations by reviewing provider and recipient records, making determinations of medical necessity, and verifying whether services...

RESPONSIBLE FOR:Detailed review, analysis and extraction of clinical information from patient medical records and drafting ofeffective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied casesunder appeal at all levels of the government appeals process; maintaining current knowledge base ofmedical coding, federal and...

Job SummaryAs a Nurse Investigator with the Georgia Department of Law, you will play a critical role in uncovering and preventing healthcare fraud within the Medicaid program. Under the direction of the Fraud Unit Director, you will assist in conducting thorough investigations by reviewing provider and recipient records, making determinations of medical...

About Us:Bringing True Hospitality to the world.We want to welcome you to a world of bringing True Hospitality to everyone. When you join us at IHG, you become part of our global family. A welcoming culture of warmth, honesty and a passion for providing True Hospitality.We pride ourselves on letting your personality and passions shine, recognizing the...