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Job Description
Job Description...
* Performs utilization management reviews in accordance with federal and state regulations
* Maintains compliance with regulatory changes affecting utilization management
* Perform UM reviews (prospective/concurrent/retrospective) for inpatient services according to the NCQA, URAC, CMA & DOH standards and client requirements and/or policies
...

We’re unique. You should be, too.
We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?
We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.
The Physician Revie...

We’re unique. You should be, too.
We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?
We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.
The Physician Revie...

Job Category:
Revenue Cycle
Work Shift/Schedule:
8 Hr Morning - Afternoon
Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.
About the Role:
Job Summary
The Coding Quality Reviewer II is responsible for performing quality analysis of coded medical records, documenting the analysis, summarizing the metrics and reporting quality statisti...

JOB SUMMARY
The Customer Service Representative is responsible for receipt of new cases and ensuring proper system drafting and setup. The CSR also is responsible for taking direction and facilitating the case assignment/scheduling process.
Dane Street's success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility...

JOB SUMMARY
The NY Workers' Compensation CSR / IME SCheduler is responsible for receipt of new cases and ensuring proper system drafting and setup. The CSR also is responsible for taking direction and facilitating the case assignment/scheduling process.
Dane Street's success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the r...

Overview
Empower AI is AI for government. Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions. Our proven Empower AI Platform® provides a practical, sustain...

Company Overview
Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.
Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership...

Job Title
Clinical Services Specialist RN
Job Type
Full-Time
Category
Medical Services
Location
Work from Home FSM Based - Fort Smith, AR 72903 US (Primary)
Education
Associate Degree
Travel
0 - 10%
Job Description
SCOPE OF POSITION:
Responsible for analyzing patient records to determine legitimacy and necessity of medical services in compliance with government reimbursement policies. Review m...

Lyric is an AI-first, platform-based healthcare technology company, committed to simplifying the business of care by preventing inaccurate payments and reducing overall waste in the healthcare ecosystem, enabling more efficient use of resources to reduce the cost of care for payers, providers, and patients. Lyric, formerly ClaimsXten, is a market leader with 35 years of pre-pay editing expertis...

Company :
Highmark Inc.
Job Description :
JOB SUMMARY
This job provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan’s state and federal multiple drug benefit design offerings. The incumbent responds to physician and pharmacy network provider inq...