Medical Necessity Review Specialist

Job DescriptionWe are seeking a skilled Healthcare Utilization Review Specialist to support our Residential, PHP, and IOP levels of care. This individual will be responsible for conducting reviews, case consultations, and interfacing with insurance payers to obtain continued authorization.Responsibilities:Conduct thorough reviews of comprehensive client...

Job Title: Medical Claims ReviewerJob Description:We are seeking a skilled professional to review medical claims for medical necessity. This involves assessing and interpreting customer needs, requirements, and medical records.Responsibilities:Review medical claims for medical necessityAssess and interpret customer needs, requirements, and medical...

The role of a Utilization Review Specialist involves assessing and interpreting customer needs, requirements, and medical records. This position requires a strong understanding of medical necessity and the ability to review medical claims effectively.Key responsibilities include:Reviewing medical claims for medical necessityAssessing customer needs and...

Job OpportunityWe are seeking a detail-oriented professional to fill the position of Clinical Review Specialist.This role requires conducting thorough reviews, case consultations, and interacting with insurance payers to secure continued authorization. The ideal candidate will be a licensed clinical or medical professional well-versed in behavioral health...

As a skilled Medical Reviewer, you will be responsible for managing patient wound care records, verifying insurance eligibility and coordinating the supply of essential medical materials.This role is ideal for individuals with a strong background in clinical wound care and excellent communication skills. You will work closely with the Payer team to determine...

Medical Billing SpecialistWe are seeking a skilled Medical Billing Specialist to join our team. In this role, you will assist in the timely and accurate processing of medical claims, ensuring that carriers receive all necessary information.Key Responsibilities:Review medical necessity appeals to ensure accuracy and completenessFax appeals to the appropriate...

Job Title:Peer Review SpecialistAbout the Role:This role supports Residential, PHP, and IOP levels of care by conducting peer reviews, case consultations, and interfacing with insurance payers. The ideal candidate is a licensed clinical or medical professional familiar with behavioral health documentation and insurance requirements.Main...

Medical File Reviewer JobWe are seeking a detail-oriented and organized Medical File Reviewer to perform medical record review and analysis tasks.Key Responsibilities:Prepare case files and Disability Benefits Questionnaires (DBQs) assigned through the client portal.Review and summarize medical records, identifying key findings and creating detailed...

Optimizing Patient CareThe role of a Utilization Management specialist involves assessing and interpreting customer needs, requirements, and medical records to ensure the best possible outcomes for patients.Key Responsibilities:Reviewing medical claims for medical necessity to provide accurate and timely information to customersCoordinating patient care by...

Medical Case Review SpecialistWe are seeking a highly skilled Medical Case Review Specialist to join our dynamic team. The ideal candidate will have a strong understanding of pharmacovigilance principles, adverse event reporting, and causality assessment.The successful candidate will be responsible for entering vigilance cases into relevant databases...