Physician ED Claims Reviewer

< data-start="65" data-end="90">Required Skills:Active US Physician license (MD/DO).35 years of recent clinical experience (within the last 23 years) in Emergency Department (ED) Medicine.Experience in Internal Medicine is also acceptable.Experience in Managed Care environments.Expertise in conducting clinical review of claims and UM authorization requests for medical necessity.Hands-on experience with Utilization Management (UM) case reviews.Knowledge of medical coding, including CPT and HCPCS

Job Title: Clinical Pharmacist Reviewer Location: Remote Duration: Contract Job Summary: Seeking a Pharmacist Reviewer with an active US Pharmacist license and strong clinical pharmacy experience. The ideal candidate will have 5+ years of pharmacist experience, including 3+ years in a hospital setting, along with expertise in managed care, clinical authorization, claims review, and clinical coding. Key Requirements: Active and unrestricted US Pharmacist license5+ years of pharmacist experience3+

Job Title - Medical Director (with active medical state licensure required for PA, NY, or WV) Location Remote Duration 6 months Contract with the possibility of contract-to-hire Medical Director Job Description This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medic

As aPre-AuthConsultantyou will be a part of an Agile team to build healthcare applications and implement new features while adhering to the best coding development standards . Mandatory skills FACETS UM/Pre-Auth Configuration ITS/Authorization Routing Logic SQL & Rule Traceability Responsibilities: - 7 - 10 years in UM/Pre-Auth configuration within FACETS. Familiarity with UM workflows, clinical guidelines, and state mandates. Experience working with clinical/utilization management stakeho