Core Responsibilities Include: Overseeing referrals to and from physician review. Performing clinical and medical reviews, data collection and database entry. Assisting in the transcription of physician reviews by editing and formatting. Qualifications Include:
Review appeals for denied services related to current relevant medical experience or knowledge. Discuss with referring physicians to clarify clinical information and to explain review outcome decisions. Qualifications Include: M. D. or D. O. with a current, active, U. S. state medical license.
Coordinating and facilitating quality, cost-effective care. Providing coordination of care between the patient, family, physician, provider and care teams. Helping improve the lives of our patients by working with them to prevent complications. Required Skills:
Interacting with Physician Advisors to discuss clinical/authorization questions. Determining appropriate level of care related to mental health and substance use treatment. Performing telephonic or paper case review and authorization determinations. Position Requirements Include: