to Physician for consultation or to specialized health resources for treatment. Maintains medical records using (In some health... centers it may be using Electronic Medical Record software). Educates and coaches nursing staff on best nursing practices...
services that do not meet utilization review criteria and renders a clinical opinion about the medicalservice under review... American Board of Medical Specialties or American Osteopathic Association) ? Three (3) or more years of relevant clinical...
or to specialized health resources for treatment. Maintains medical records using (In some health centers it may be using Electronic... Medical Record software). Educates and coaches nursing staff on best nursing practices. May require other duties as assigned...
Job Description: Utilize medical necessity criteria from established medical policies and clinical practice... guidelines to render precertification determinations as described in the Medical Management UM work plan. This detailed clinical...
Job Description: Monitor the performance and address issues with any business partners or vendors that supports the Members Servicing Department. Build relationships with both internal and external customers to include members and emplo...
Job Description: Sustains mastery of encounter system processes within HMSA and external partners, for multiple lines of business. Monitors trends in data exchange with external entities and recommends adjustments as needed. Researches...
Job Description: Analyzes encounter system processes within HMSA and external partners. Coordinates and reconciles exchange of data with external entities. Researches various claim-member-provider scenarios to determine root cause of d...
Job Description: Sustains strong knowledge of encounter system processes within HMSA and external partners. Coordinates and reconciles data exchange with external entities, monitoring quality. Researches complex claim-member-provider s...
Job Description: Stakeholder Management: Build strong relationships with stakeholders at all levels, understanding their needs, and ensuring clear communication throughout the product development lifecycle. Understand stakeholders' ...
to laptop. Provides input regarding port availability, equipment locations, device installations and service during project... and assists with Internet access. Assists external users with dial-up access problems. Coordinates and sets up access or service...