Board-certified rheumatology physician to review independent medical exams (IMEs), insurance appeals, and prospective/retrospective claims, assessing medical necessity and adherence to evidence-based guidelines and client policies. Responsible for interpreting services provided by other healthcare professionals and providing clinical opinions in line with standards of care. Serves as a physician reviewer/advisor to support utilization review, appeals adjudication, and medico-legal determinations.
As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client specific policies, nationally recognized evidence-based guidelines, and standards of care.
rheumatology, medical review, independent medical exam, insurance appeals, utilization review, medical necessity, claims review, evidence-based guidelines, clinical consultation
...remain injury free, always. Champion safety procedures, processes and training to create and maintain a safety-first culture in the Transportation department. Oversee and develop drivers and Transportation associates through one-on-one coaching, training on policy and...
: Location: Brookshire, US Job Family: Supply & Logistics Country/Region: United States Job Function Summary Lead and further develop direct reports as well as team members Supervise day-to-day operations adhering to all operational processes Manage activities within...
...Job Description GLC On-The-Go is seeking a travel nurse Correctional for a travel nursing job in South Burlington, Vermont. Job Description... ... were your trusted partner in finding travel, local, and PRN contracts that align with your career aspirations and lifestyle....
...Nurse Practitioner | Cardiology - General/Other Location: The Dalles, OR Employer: CompHealth Pay: $80 to $100 per hour Start... ...obligations, combining work with leisure and discovery. # Explore telemedicine or remote healthcare opportunities through locum...
...Position Title: STUDENT ATHLETE DINING SUPERVISOR - Camp Randall & Kohl Center Pay Range : $19 to $22 From the stadium to the head table, Levy leverages unbridled creativity, custom strategies, impeccable service, and true love for great food to create...