A staffing agency is filling a position for a Remote Medical Auditor in Baltimore County. Individual must be able to fulfill the following responsibilities: Perform evaluation of medical records and claims as it pertains to fraud, waste and abuse.
Determining medical appropriateness of inpatient and outpatient services. Ensuring proper utilization of health services. Identifying solutions to problems and non-standard requests. Applicants must meet the following qualifications: 2+ years of acute hospital clinical experience.
Familiarity with Milliman and InterQual guidelines. In-depth knowledge of current standard of medical practices. Strong knowledge of case-management processes. Detailed knowledge and competency in all types of medical-necessity decisions. Strong nursing expertise in managing patients.
Must be able to: Determine medical appropriateness of inpatient and outpatient services. Ensure proper utilization of health services. Identify solutions to problems and non-standard requests. Skills and Requirements Include: 2+ years of acute hospital clinical experience.
HS Diploma, Vocational Training or Equivalent. Minimum 6 years related healthcare experience. Strong medical laboratory knowledge. Ability to prioritize and multi-task to meet various deadlines. ntermediate working knowledge of Microsoft Office, IE, and research tools.
Proficient in Microsoft Office (Outlook, Work, Excel and Powerpoint) Knowledge of Medical terminology. Understanding of health care, PBM, and pharmaceutical industries. Solid analytic skills with ability to understand and interpret data.
A healthcare provider is filling a position for a Telecommute Medical Director. Core Responsibilities Include: Ensuring medical compliance with all customer, regulatory, and accreditation requirements for clinical services.
A healthcare staffing company is seeking a Remote IP Denials Medical Coder in Cleveland. Must be able to: Assign ICD-10 and/or CPT/HCPCS codes. Ensure client's production and quality expectations are met. Complete coding of all discharges/encounters.
A healthcare company needs applicants for an opening for a Telecommute Appeals and Grievances Behavioral Medical Director Psychiatrist. Core Responsibilities Include: Making clinical coverage determinations. Providing clinical oversight to the clinical staff.
Perform medical record review for HEDIS and HEDIS-like measures. Perform over-read of medical records. Qualifications for this position include: 1+ year healthcare/health plan experience. 1+ year HEDIS experience and/or knowledge. Home internet is required.