: MEDICAL REVIEWER III Conducts medical record audits to determine the medical necessity and/or appropriateness of medical... in a medical/surgical setting At least two (2) years of medical record audit experience Familiarity with Medicaid and/or CHIP...
MEDICAL REVIEWER III Conducts medical record audits to determine the medical necessity and/or appropriateness... in a medical/surgical setting At least two (2) years of medical record audit experience Familiarity with Medicaid and/or CHIP...
Overview: Medicare Medical Review RN (Medical Reviewer III) - REMOTE The Medicare Medical Review RN (Medical... Reviewer III) will primarily be responsible for conducting clinical reviews of medical records during the course of fraud...
determination guidance. Classify order packets as (i) clearly meets payor guidance as to medical necessity, (ii) based on reviewer...’s opinion, meets payor guidance as to medical necessity (with written opinion), (iii) clearly does not meet payor guidance...
and regulations by accrediting agencies such as Centers for Medicare/Medicaid Services (CMS). Reviewer: Clinical director... and medical staff committees when needed. Reviewer: Clinical director for quality. 3. Coverage & On Call Responsibilities...