Possession of an active, unrestricted, and unencumbered Certified Site Reviewer Certificate issued from DHCS or participating Medi-Cal Managed Health Plan Provider. ...
E'S with FDOT experience in design and analysis of stormwater management and drainage systems, flood studies, bridge hydraulics and scour countermeasures.This role will be a 50% split between time on review of FDOT access and drainage connection permits and 50% in a design role on highways, flood mi...
Under the direction of the Nurse Director of the BWPO's South Shore Endoscopy Center (SSEC), the Registered Nurse GI Case Reviewer will work as a critical member of the procedural care team to support the quality, efficiency and satisfaction of care taking place at the SSEC. ...
Within the Finance Department, the Financial Review is a dedicated and independent function in charge of permanent controls on accounting and financial information.The Financial Review is a key component of the Enterprise Risk Management framework.As part of the second line of defense, it consists o...
What You’ll Be Doing:As a Vascular Surgery , Physician Clinical Reviewer you will be a key member of the utilization management team. What You Will Be Doing:Serve as the specialty match reviewer in Vascular Surgery cases, that do not initially meet the applicable medical necessity guidelines, as wel...
Click on Learn more about this agency button below to view Eligibilities being considered and other IMPORTANT information.WHERE CAN I FIND OUT MORE ABOUT OTHER IRS CAREERS? Visit us on the web at www.Career transition (CTAP, ICTAP, RPL).Federal employees who meet the definition of a surplus or displ...
Physician Clinical Reviewer, MRx - Oncology - REMOTE. Routinely interacts with physicians, leadership and management staff, other Physician Clinical Reviewers (PCR), and health plan members and staff whenever a physician`s input is needed or required. Reviews all cases in which clinical determinatio...
Click on Learn more about this agency button below to view Eligibilities being considered and other IMPORTANT information.WHERE CAN I FIND OUT MORE ABOUT OTHER IRS CAREERS? Visit us on the web at www.Career transition (CTAP, ICTAP, RPL).Federal employees who meet the definition of a surplus or displ...
Why This Role is Important to Us:**.Reporting to the VP Quality & Controls Assurance, the incumbent is responsible for independent quality reviews of medical claims, and evaluating Call Center activities for compliance with policies and Standard Operating Procedures (SOP).Additionally, this role wil...
Click on Learn more about this agency button below to view Eligibilities being considered and other IMPORTANT information.WHERE CAN I FIND OUT MORE ABOUT OTHER IRS CAREERS? Visit us on the web at www.Added additional cut off of 3/15/2024.Adding additional Specialty areas: Whistleblower Office Case D...
Under the general direction of the NIPR Manager or designee, Clinical Reviewer Auditor is tasked with the responsibility to perform and oversee retrospective, post-payment case reviews of community-based providers who participate in MassHealth. The Clinical Reviewer Auditor works within specific gui...
Subject Expert Reviewer needed. ...
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Remote/work-from-home opportunity, reviewers must reside in one of the following states: Illinois, Virginia, Maryland, Massachussetts, or DC . ...
Pittsburgh, Pennsylvania; Massachusetts; Delaware; Florida; Remote ....
The Reviewer functions under the general supervision of the Unit Manager. ...
Under the general direction of the NIPR Manager or designee, Clinical Reviewer Auditor is tasked with the responsibility to perform and oversee retrospective, post-payment case reviews of community-based providers who participate in MassHealth. The Clinical Reviewer Auditor works within specific gui...
Nurse Reviewer, Endoscopy -Braintree-(3288945). Under the direction of the Nurse Director of the BWPO’s South Shore Endoscopy Center (SSEC), the Registered Nurse GI Case Reviewer will work as a critical member of the procedural care team to support the quality, efficiency and satisfaction of care ta...
Remote position but will be required to go on site as needed.Coordinates the review process for services requiring prior authorization by .This includes matching the coverage request to the Medical Necessity Guidelines/Interqual Criteria or Plan Benefit Documents, documentation of the coverage deter...
NECO has an exciting opportunity in our Commonwealth Clinic for a Patient Billing and Claims Reviewer. The Patient Billing and Claims Reviewer (On-Site) will be located at 930 Commonwealth Avenue in our Commonwealth clinic. Patient Billing and Claims Reviewer (On-Site) Responsibilities:. Patient Bil...
Under the general direction of the NIPR Manager or designee, Clinical Reviewer Auditor is tasked with the responsibility to perform and oversee retrospective, post-payment case reviews of community-based providers who participate in MassHealth. The Clinical Reviewer Auditor works within specific gui...
Within the Finance Department, the Financial Review is a dedicated and independent function in charge of permanent controls on accounting and financial information.The Financial Review is a key component of the Enterprise Risk Management framework.As part of the second line of defense, it consists o...
Clinical Nurse Reviewer - NIPR (Hybrid - North Quincy, MA). Under the general direction of the NIPR Manager or designee, Clinical Reviewer Auditor is tasked with the responsibility to perform and oversee retrospective, post-payment case reviews of community-based providers who participate in MassHea...
The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines and rules, evidence based clinical criteria plan, and policy exclusions. ...
Nurse Reviewer, Endoscopy -Braintree-(3288945). Under the direction of the Nurse Director of the BWPO’s South Shore Endoscopy Center (SSEC), the Registered Nurse GI Case Reviewer will work as a critical member of the procedural care team to support the quality, efficiency and satisfaction of care ta...