annual policy reviews and updates and ensure utilization review processes align with InterQual Clinical Care Guidelines...

identify opportunities for product and process improvement, support design reviews and Integrated Product Teams (IPTs... Integrated Product Teams (IPTs) and participate in design reviews. Represent the engineering organization in the build and post...

concurrent and retrospective reviews to evaluate the appropriateness, quality, and efficiency of care based on the patient...

services to ensure level of care and services are medically appropriate Performs prior authorization reviews related to mental...

Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the... required. ICU or ER experience preferred. Performs concurrent reviews of member for appropriate care and setting to determine...

identify opportunities for product and process improvement, support design reviews and Integrated Product Teams (IPTs... Integrated Product Teams and participate in design reviews. Represent the engineering organization in the build environment...

® software. As time permits, identify trends from such reviews to help the Manager make improvements to the overall work...

, Itemized Bill Review Quality Auditor to perform reviews of medical records, healthcare claims, itemized medical bill, and UB-04..., reimbursement methodologies, payment integrity, and claim auditing. The Lead Associate performs comprehensive quality reviews...

reviews. Works with the Physicians and the Social Services department to ensure quality of documentation of patient care... to assure timely and appropriate interactions, monitor outcomes of reviews and provide consultation as needed. Review the...

reviews. Review patient records, clinical documentation, and treatment plans. Determine medical necessity and appropriate... and DragonFly UM for reviews and documentation. Communicate with providers regarding authorization and utilization matters...

credit rating models and methodologies across corporate credit review reports and targeted credit reviews Analyze and verify...

, Itemized Bill Review Quality Auditor to perform reviews of medical records, healthcare claims, itemized medical bill, and UB-04..., reimbursement methodologies, payment integrity, and claim auditing. The Lead Associate performs comprehensive quality reviews...

through quarterly Business Monitoring and periodic Reviews. Assessment of the quality of assigned portfolios... from Reviews or Business Monitoring, and subsequent validation of the effectiveness of the same after implementation by the...

reviews. Review patient records, clinical documentation, and treatment plans. Determine medical necessity and appropriate... and DragonFly UM for reviews and documentation. Communicate with providers regarding authorization and utilization matters...

reviews. Review patient records, clinical documentation, and treatment plans. Determine medical necessity and appropriate... and DragonFly UM for reviews and documentation. Communicate with providers regarding authorization and utilization matters...

with configuration audits, reviews, and compliance assessments. Ensure program artifacts meet customer, contractual, and organizational...

reviews. Review patient records, clinical documentation, and treatment plans. Determine medical necessity and appropriate... and DragonFly UM for reviews and documentation. Communicate with providers regarding authorization and utilization matters...

@mercor.com PS: Our team reviews applications daily. Please complete your AI interview and application steps...

reviews. Review patient records, clinical documentation, and treatment plans. Determine medical necessity and appropriate... and DragonFly UM for reviews and documentation. Communicate with providers regarding authorization and utilization matters...

to payer-specific timely filing requirementsMonitor authorizations for expiration and proactively manage concurrent reviews... and payer-specific guidelinesProven ability to manage high caseloads and concurrent reviews in a fast-paced...