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....season. Check daily bookings on our Fare Harbor platform Clean boats of dew, debris, and garbage Put gas in boats (Meredith Marina, Mountain View Yacht Club, and Flight Craft General) Equip boats with towels, blankets and water Assist cruisers with...
...experience in Adult Intensive Care Unit, Critical Care Unit, or Medical Surgery Unit. Active RN license Resume must reflect all... ...Clinical Documentation Integrity working with Concurrent Chart Review. 2 Years of Epic Experience. Experience with Nuance CDE a...
VetsEZ is seeking a Quality Assurance Analyst to support testing and software quality for a VA initiative reducing SSN usage in VistA apps. Responsibilities include creating test cases, executing tests, and documenting defects across ADT, PCE, AICS, and related packages...
...should effectively communicate with development, management, and the test teams to ensure business requirements have been met and all QA software release documents have been generated.Roles And ResponsibilitiesReview requirements with project teams for testability....
...IT-QA Test The Finance platform is looking for an IT-QA Test resource with 3-5+ years of experience. This team is responsible for taking data from their finance sister team in SQL and testing and reporting in Excel. They will also be responsible for pulling reports...