, trends and quality improvement needs. Participate in clinical determinations, including denials, outlier management...
and/or consultation from Care Coordination leadership with plans for outlier and potential or actual resource intensive patients. 9...
Network), Page Rank, Centrality Analysis, Tree based Analysis, Outlier Detection Methods, Zero Shot/ Few Shot learning...
to an appropriate QA standard to validate actual expert performance versus expectations, and provide feedback in support of outlier...
or continued stay and physician documentation. Participates in daily interdisciplinary planning meetings and weekly outlier case...
as per department guidelines adhering to frequency requirements and standards for quality control performance. • Reports all outlier...
the Case Management needs of patients. 4. Reviews Outlier patients and discusses with interdisciplinary team, medical... job description by taking initiative and ownership of the job responsibility tasks. 16. Rounds on outlier or complex patients to ensure...
, outlier identification, and timely quarterly submission. Lead regional review and validation of STS Adult Cardiac Surgery...
(data cleaning, querying, visualization, etc.) Support the quarterly Outlier review process for MR Group reporting...
. (10%) - Identify opportunities for, and contribute to, FWA mitigation strategies including claim system edits, outlier...