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HealthFirst
Overview
The Medical Peer Reviewer consults on medical necessity within utilization management, ensuring adherence to internal and external regulations by assessing authorization requests and claims payments based on medical records. This role involves rendering determinations within regulatory timeframes, maintaining productivity standards, and collaborating across various medical and management departments.
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Compensation
$122,907 - $188,020 / YEAR
Posted
10 days ago
Federal Hearings And Appeals
Responsible for reviewing medical case files and making medical determinations. Reviews and analyzes Federal and State laws, regulations, and applicable policy guides.
Salary not listed
17 days ago
The Physician Peer Reviewer is responsible for reviewing medical case files and making medical determinations regarding medical necessity and appropriateness. This includes analyzing Federal and State laws, regulations, and applicable policy guides.
25 days ago
MICHIGAN PEER REVIEW ORGANIZATION
The Peer Reviewer will apply clinical expertise to evaluate cases, specifically assessing medical necessity and/or the standard of care to enhance healthcare quality and professional integrity. Duties include conducting objective, evidence-based reviews, making final determinations on medical necessity and quality of care, and submitting timely, professional reports using provided IT systems.
2 months ago
University of Miami
The Assistant Scientist will conduct basic and applied research activities, author scientific publications, and contribute to the scientific community by publishing findings. This role involves creating and conducting experiments, analyzing results, and collaborating with senior staff on research agendas supporting the University's goals.
Responsible for reviewing medical case files and making medical determinations. This includes analyzing Federal and State laws, regulations, and applicable policy guides.
4 months ago
