Reviewing medical records to abstract information according to the required standards. Completing edit checks and making appropriate changes on a timely basis. Applicants must meet the following qualifications:
A property and casualty insurance company is searching for a person to fill their position for a Telecommute Medical RN Case Manager. Core Responsibilities Include: Providing telephonic case management on assigned workers’ compensation claims.
A medical benefits management solutions provider needs applicants for an opening for a Remote Associate Cardiology Medical Director. Must be able to: Provide expert medical review for service requests that do not meet criteria.
A healthcare and health insurance company is filling a position for a Virtual Adolescent Psychiatrist Medical Director. Core Responsibilities Include: Serving as a mentor/coach/trainer for care managers in a quality improvement process.
Performing clinical and medical reviews, data collection and database entry. Assisting in the transcription of physician reviews by editing and formatting. Qualifications Include: May be required to travel at least 10% of time based on business needs. Unrestricted RN license required.
Coordinating Community-based management of medication therapy. Applicants must meet the following qualifications: Ability to meet with members face-to-face at a regular frequency. GED or High School Diploma.
Supporting members with condition education, medication reviews and connections to resources. Assisting members with the transition from a care facility back to their home. Must meet the following requirements for consideration: Access to reliable transportation and travel approximately 25%
A health insurance company is in need of a Telecommute Medical Case Manager. Core Responsibilities Include: Educating members in order to enhance member understanding of illness/disease impact. Identifying, defining and resolving a myriad of problem types experienced by the member.
Reviewing requests for prior authorization of medical services. Reviewing provider requests to ensure medical necessity for services requiring preauthorization. Utilizing nationally recognized criteria to determine medical necessity of services requested.
Ensuring member access to medical necessary, quality healthcare in a cost effective setting. Collaborating with provider to identify proactive discharge planning for members. Position Requirements Include: Virginia residency required.