Medical Necessity Consultant

Job OverviewThis role involves conducting peer reviews and clinical case consultations with insurance payers to secure continued stay authorizations.The ideal candidate will be a licensed clinical or medical professional who is deeply familiar with behavioral health documentation and insurance requirements.Main ResponsibilitiesConduct comprehensive chart...

Utilization Review Specialist Job DescriptionWe are seeking a skilled Utilization Review Specialist to assess and interpret customer needs, requirements, and medical records.The ideal candidate will possess an active PHRN and USRN Mainland License, as well as 1 year of bedside experience, preferably with UR/UM experience.Assess and interpret customer needs,...

Job OpportunityThis role is designed for a licensed clinical or medical professional with expertise in behavioral health documentation and insurance requirements.The ideal candidate will be responsible for conducting peer reviews, case consultations, and interfacing with payers to obtain continued authorization.Key Responsibilities:Conduct comprehensive peer...

Job Summary:The Medical Billing Appeals Assistant role requires assisting a team to meet responsibilities in a timely and accurate fashion.Key Responsibilities:Review appeals for medical necessityFax appeals to the appropriate partySet reminders to follow up on appeal statusConfirm provider ability to service new membersAttend weekly team meetings and...

Utilization Review Specialist Role OverviewThis role is centered on assessing and interpreting customer needs, requirements, and medical records to ensure accurate and efficient review of medical claims.Key Responsibilities:Assess and interpret customer needs, requirements, and medical recordsReview medical claims for medical necessityAs a Utilization Review...

Job Title: Medical ReviewerThe Role:We are seeking a skilled medical professional with expertise in wound care to manage patient wound care records, verify insurance eligibility, and coordinate the supply of essential medical materials.Key Responsibilities:Manage records progress for wound care intakePull reports and documents for patients who are at home...

Job Title: Clinical Review SpecialistAbout the JobWe are seeking a highly skilled Clinical Review Specialist to join our team.The successful candidate will be responsible for assessing and interpreting customer needs, requirements and medical records.Key Responsibilities:Reviews medical claims for medical necessityAssesses and interprets customer needs,...

Job Description:">We are seeking a detail-oriented and highly skilled professional to support our Residential, PHP, and IOP levels of care. This individual will be responsible for conducting peer reviews, case consultations, and interfacing with insurance payers to obtain continued authorization.">Key Responsibilities:">">Conduct comprehensive client chart...

Expert Wound Care SpecialistWe are seeking a skilled professional to manage patient wound care records, verify insurance eligibility, and coordinate the supply of essential medical materials.Pull reports and documents for patients who are at home with wounds at time of review. Communicate with the Payer team to determine which patients have insurance...

Job SummaryWe are seeking a highly skilled and detail-oriented Clinical Review Expert to support our Residential, PHP, and IOP levels of care.This individual will be responsible for conducting clinical reviews, case consultations, and interfacing with insurance payers to obtain continued authorization.Main ResponsibilitiesConduct thorough clinical reviews...