as liaison for outsourced and co-sourced reviews in the credit risk portfolio and is the primary contact and business partner... Assist in planning for and managing the completion of outsourced and co-sourced reviews Represent Internal Credit Review...

. Performs Level I Medical Peer Reviews, documents summary of case review. Facilitates the referral of issues to the appropriate...

. Performs Level I Medical Peer Reviews, documents summary of case review. Facilitates the referral of issues to the appropriate...

understands the management of UM data obtained from admission, concurrent reviews and appeals utilizing the Severity of Illness...

understands the management of UM data obtained from admission, concurrent reviews and appeals utilizing the Severity of Illness...

of working, governance). Build and maintain portfolio management routines and governance (e.g., portfolio reviews/PMRs, Stage...

, and resources that support audit quality and Association priorities Perform technical reviews and oversight activities and support...

and evaluators, establishes the appropriate valuation product and scope of work, and reviews commercial and residential appraisals... for third-party appraisal reviews when appropriate. Analyze market data, valuation trends, collateral risk, and report findings...

. (Preferred) Previous experience performing medical necessity and clinical reviews in a health plan setting. (Preferred) Prior...

and appropriateness of patient care. Conducts admission reviews for Medicare, Medicaid beneficiaries, as well as private insurers.... Performs concurrent and retrospective clinical reviews with various payers, utilizing the appropriate guidelines...

. How you'll contribute A Utilization Review Specialist who excels in this role: Facilitates clinical reviews for all patient... with physicians to schedule peer-to-peer reviews. Accurately reports denials. About our Team Driven by a mission to help...

reviews. This position combines clinical leadership with deep expertise in facility reimbursement and healthcare revenue...-payment facility claim reviews Manage and develop clinical leaders and staff to achieve productivity, quality, and financial...

to complete the assigned reviews. Who This Is For This opportunity is for active physicians who are comfortable reviewing... AI-proposed diagnoses for accuracy and clinical relevance Dedicate a minimum of five hours to complete the case reviews Who...

reviews and examinations as an Examiner-in-Charge or Assistant Examiner-in-Charge, ensuring timely and accurate execution.... Perform secondary reviews of transactional testing performed by junior team members and manage issues including severity...

Manager to help take Gitar from a fast-growing standalone product to a core part of how the world reviews AI-generated code...

contribute Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR... and on a timely basis. Interface with managed care organizations, external reviews, and other payers. Communicate with physicians...

occupational medicine and drug testing services. Reviews and interprets drug test results, including determining legitimate...

risk-based coverage plans, perform detailed transaction reviews, lead examinations, identify existing and emerging risks... on transaction reviews Track and follow up on observations and findings from examinations Manage issues, including severity ratings...

stakeholders to support high-quality valuation reviews. This is a US-based role open across 48 states, with a preference.... You will help maintain consistency and quality across valuation reviews within an institutional investment environment...

serves as a subject matter expert for itemized bill reviews and analyzing hospital facility bills. The clinical reviewer... preparation of Forensic Reviews for specific clients. Employees in this position receive limited supervision within a broad...