Medical Necessity Specialist

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,...

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...

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 OpportunityThe Utilization Management Specialist plays a pivotal role in assessing and interpreting customer needs, requirements, and medical records. This position demands active licensure and participation in professional networks.Experience in bedside care with UR/UM experience is preferred but not required.

Utilization Management Specialist About the Role:We are seeking a highly skilled Utilization Management specialist to join our team. The ideal candidate will have expertise in assessing and interpreting customer needs, requirements, and medical records. Key Responsibilities:Review medical claims for medical necessity.Develop and implement effective...

Job SummaryWe are seeking an experienced Billing Professional to manage the billing and collection processes in a healthcare environment, particularly for skilled nursing facilities with proficiency in using PointClickCare.Key ResponsibilitiesBilling Management: Ensure timely and accurate submission of claims for Medicare, Medicaid, and other third-party...

Are you looking for a challenging and rewarding career in the medical field?Job DescriptionWe are seeking a highly skilled Medical Scribe to join our team. As a Medical Scribe, you will play a vital role in supporting clinicians in their daily tasks, focusing on patient care and hands-on treatment.Your key responsibilities will include:Accurately documenting...

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 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...

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,...