- US Tech Solutions (Canton, MA)
- …frames. The Clinical Reviewer functions as a member of the Precert / Outpatient UM team and works under the general direction of the Precertification Team ... Proactively identifies trends in Utilization Management applicable to the precertification and outpatient UM processes. ssists in the screening of appeal cases… more
- US Tech Solutions (Canton, MA)
- …frames. The Clinical Reviewer functions as a member of the Precert / Outpatient UM team and works under the general direction of the Precertification Team ... + Proactively identifies trends in Utilization Management applicable to the precertification and outpatient UM processes. + Assists in the screening of appeal… more
- Humana (Providence, RI)
- …key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus on our 5+ million ... need to be well versed in CMS knowledge of outpatient , inpatient and appeal criteria including regulation and policies....be the liaison for the Medicare Market Provider Experience Clinician . This position can be located anywhere within the… more
