pay rate is ***/hour fully remote, but must reside in one of our plan states: IL, TX, NM, OK, MT, TN 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. Practices anticipatory case management for members whose cases come for review, in partnership with case managers. 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.) Required hours: Monday through Friday, 8a-6p - intermittent coverage of weekend shifts EEO: "Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
...Community and Family Resources is seekinga dynamic individual to join our medical billing team. This position works under our Revenue Cycle Manager to complete all duties related to billing clients for behavioral health services. The role is located at our Iowa City location...
...productive and efficient environment. Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable. Benefits You Need & Then Some Avera is proud to offer a wide range...
Job Description: Sign-on Bonus Eligible MLT: $24.48 - $36.72Will perform and report tests of all complexity levels, as defined by CLIA, on patients of all ages to assist with the routine screening, diagnosis, treatment and management of diseases and injuries. Will...
...Overview: Role: React JS Developer Location: Onsite - Irving, TX / Minneapolis, MN / Charlotte, NC Overview: We are looking for an experienced React JS Developer to build and maintain high-quality web applications. The ideal candidate will have strong...
...are interested in working in a fulfilling environment, please look below for additional job description details. SUMMARY: The Cook position is responsible for overseeing all aspects of TH residential food services on the weekend and when the Executive Chef is not...