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* Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD...
* Work to improve quality and promote evidence-based medicine * Provide information on quality and efficiency to doctors, patients and customers...
* Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage...
* Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage...
* Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage...
* Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage...
* Provide daily utilization oversight and external communication with network physicians and hospitals * Daily UM reviews - authorizations...
* Work to improve quality and promote evidence-based medicine * Provide information on quality and efficiency to doctors, patients and customers...
* Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage...
* Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage...
* Provide daily utilization oversight and external communication with network physicians and hospitals * Daily UM reviews - authorizations...
* Provide daily utilization oversight and external communication with network physicians and hospitals * Daily UM reviews - authorizations...
The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for...
* Work to improve quality and promote evidence-based medicine * Provide information on quality and efficiency to doctors, patients and customers...
* Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage...
* Provide daily utilization oversight and external communication with network physicians and hospitals * Daily UM reviews - authorizations...
* Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage...
* Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage...
* Support case and disease management teams to achieve optimal clinical outcomes for high risk populations * Proficient in evidence based clinical...
* Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage...
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