Remote
Description: 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. 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.The company and other persons or employers are released from all liability brought forth by any investigation resulting from my submission of this electronic application and the data contained here in.The information in this application is true and complete to the best ...
...Travel LPN Company: Fusion Medical Staffing Location: Facility in Bolivar, MO Job Details Fusion Medical Staffing is seeking a skilled Licensed Practical Nurse for a 13-week travel assignment in Bolivar, MO. As a member of our team, youll have the opportunity...
Rigging Opportunities At SeaArk Boats SeaArk Boats has been in business since 1992 and joined the Correct Craft team in early 2016. Our team is comprised of over 150 men and women who know the importance of a well-built product working together to create boats that...
Job Description: Primary Responsibility This position provides bibliographic instructional and information retrieval and reference services, catalogues and classifies materials, instructs/assists users; compiles data; prepares reports; and assists in operations...
Design, code and test Mainframe PLI and COBOL programsDebug code for existing programsTroubleshoot system bugs and issuesProvide production support on multiple enterprise mainframe applicationsSupport efforts related to the integrity and confidentiality of sensitive information...