Act as liaison between managed care organizations and the facility professional clinical staff ... Facilitate peer review calls between facility and external organizations. * Initiate and complete ...
Act as liaison between managed care organizations and the facility professional clinical staff ... Facilitate peer review calls between facility and external organizations. * Initiate and complete ...
Utilization Review Specialist
Tucson, AZ · On-site
Interfaces with managed care organizations, external reviewers, and other payers. * Communicates with physicians to schedule peer-to-peer reviews. * Accurately reports denials. About our Team Driven ...
Utilization Review Specialist
Tucson, AZ · On-site
Interfaces with managed care organizations, external reviewers, and other payers. * Communicates with physicians to schedule peer-to-peer reviews. * Accurately reports denials. About our Team Driven ...
Utilization Review Specialist
Tucson, AZ · On-site
Interfaces with managed care organizations, external reviewers, and other payers. * Communicates with physicians to schedule peer-to-peer reviews. * Accurately reports denials. About our Team Driven ...
Utilization Review Specialist
Tucson, AZ · On-site
Interfaces with managed care organizations, external reviewers, and other payers. * Communicates with physicians to schedule peer-to-peer reviews. * Accurately reports denials. About our Team Driven ...
Utilization Review Specialist
Gilbert, AZ · On-site
Interfaces with managed care organizations, external reviewers, and other payers. * Communicates with physicians to schedule peer-to-peer reviews. * Accurately reports denials. What we're looking for ...
Utilization Review Specialist
Gilbert, AZ · On-site
Interfaces with managed care organizations, external reviewers, and other payers. * Communicates with physicians to schedule peer-to-peer reviews. * Accurately reports denials. What we're looking for ...
Utilization Review Specialist
Gilbert, AZ · On-site
Interfaces with managed care organizations, external reviewers, and other payers. * Communicates with physicians to schedule peer-to-peer reviews. * Accurately reports denials. What we're looking for ...
Utilization Review Specialist
Gilbert, AZ · On-site
Interfaces with managed care organizations, external reviewers, and other payers. * Communicates with physicians to schedule peer-to-peer reviews. * Accurately reports denials. What we're looking for ...
Orthopedics Physician
Concho, AZ · On-site
Dane Street is a national leader in Independent Medical Examinations (IMEs) and peer review ... Respond to clinical queries to support claims management * Deliver detailed IME reports within an ...
Orthopedics Physician
Concho, AZ · On-site
Dane Street is a national leader in Independent Medical Examinations (IMEs) and peer review ... Respond to clinical queries to support claims management * Deliver detailed IME reports within an ...
Orthopedics Physician
Concho, AZ · On-site
Dane Street is a national leader in Independent Medical Examinations (IMEs) and peer review ... Respond to clinical queries to support claims management * Deliver detailed IME reports within an ...
Orthopedics Physician
Concho, AZ · On-site
Dane Street is a national leader in Independent Medical Examinations (IMEs) and peer review ... Respond to clinical queries to support claims management * Deliver detailed IME reports within an ...
Dane Street is a national leader in Independent Medical Examinations (IMEs) and peer review ... Respond to clinical queries to support claims management * Deliver detailed IME reports within an ...
Dane Street is a national leader in Independent Medical Examinations (IMEs) and peer review ... Respond to clinical queries to support claims management * Deliver detailed IME reports within an ...
Dane Street is a national leader in Independent Medical Examinations (IMEs) and peer review ... Respond to clinical queries to support claims management * Deliver detailed IME reports within an ...
Dane Street is a national leader in Independent Medical Examinations (IMEs) and peer review ... Respond to clinical queries to support claims management * Deliver detailed IME reports within an ...
CSP Utilization Review Specialist/Quality Manager
Tucson, AZ · On-site
$71K/yr
... results from peer reviews; conduct psychiatry, closed file reviews, and report results ... Manage, including the development of reciprocity agreements with the Regional Behavioral Health ...
CSP Utilization Review Specialist/Quality Manager
Tucson, AZ · On-site
$71K/yr
... results from peer reviews; conduct psychiatry, closed file reviews, and report results ... Manage, including the development of reciprocity agreements with the Regional Behavioral Health ...
Pulmonary Medicine Physician Critical Care Pulmonologist - Physicians Only Apply - Perm
Phoenix, AZ · On-site
$298K - $398K/yr
... peer review program is viewed as a critical element of quality management. Most of our reviewers find the cases interesting and the work gratifying. This is a real opportunity to ensure that our ...
Pulmonary Medicine Physician Critical Care Pulmonologist - Physicians Only Apply - Perm
Phoenix, AZ · On-site
$298K - $398K/yr
... peer review program is viewed as a critical element of quality management. Most of our reviewers find the cases interesting and the work gratifying. This is a real opportunity to ensure that our ...
Job Page
Phoenix, AZ · On-site
$70K - $143K/yr
... and peer review requirements, investigating misconduct and taking disciplinary action when ... Management and Supervision: • Direct the operations of the Board's office which oversees the ...
Job Page
Phoenix, AZ · On-site
$70K - $143K/yr
... and peer review requirements, investigating misconduct and taking disciplinary action when ... Management and Supervision: • Direct the operations of the Board's office which oversees the ...
EXECUTIVE DIRECTOR
Phoenix, AZ · On-site
$70K - $143K/yr
... Management BOARD OF ACCOUNTANCY The Arizona State Board of Accountancy protects the public by licensing CPAs and registering CPA firms, overseeing continuing professional education and peer review ...
EXECUTIVE DIRECTOR
Phoenix, AZ · On-site
$70K - $143K/yr
... Management BOARD OF ACCOUNTANCY The Arizona State Board of Accountancy protects the public by licensing CPAs and registering CPA firms, overseeing continuing professional education and peer review ...
... peer review, and compliance processes while maintaining the highest standards of confidentiality. Your day-to-day will involve coordinating medical staff committees, managing complex credentialing ...
... peer review, and compliance processes while maintaining the highest standards of confidentiality. Your day-to-day will involve coordinating medical staff committees, managing complex credentialing ...
Medical Staff Coordinator
Tucson, AZ · On-site
... peer review, and compliance processes while maintaining the highest standards of confidentiality. Your day-to-day will involve coordinating medical staff committees, managing complex credentialing ...
Medical Staff Coordinator
Tucson, AZ · On-site
... peer review, and compliance processes while maintaining the highest standards of confidentiality. Your day-to-day will involve coordinating medical staff committees, managing complex credentialing ...
... peer review, and compliance processes while maintaining the highest standards of confidentiality. Your day-to-day will involve coordinating medical staff committees, managing complex credentialing ...
... peer review, and compliance processes while maintaining the highest standards of confidentiality. Your day-to-day will involve coordinating medical staff committees, managing complex credentialing ...
Peer Support Specialist
Whiteriver, AZ · On-site
$15.75 - $20.25/hr
CHILD, ADOLECENT AND FAMILY SERVICES PROGRAM MANAGER STATEMENT OF JOB: This Position draws upon ... Participates in weekly clinical staffing with other members of the clinical team to review client ...
Peer Support Specialist
Whiteriver, AZ · On-site
$15.75 - $20.25/hr
CHILD, ADOLECENT AND FAMILY SERVICES PROGRAM MANAGER STATEMENT OF JOB: This Position draws upon ... Participates in weekly clinical staffing with other members of the clinical team to review client ...
Peer Support Specialist
$15.75 - $20.25/hr
CHILD, ADOLECENT AND FAMILY SERVICES PROGRAM MANAGER STATEMENT OF JOB : This Position draws upon ... Participates in weekly clinical staffing with other members of the clinical team to review client ...
Quick apply
Peer Support Specialist
$15.75 - $20.25/hr
CHILD, ADOLECENT AND FAMILY SERVICES PROGRAM MANAGER STATEMENT OF JOB : This Position draws upon ... Participates in weekly clinical staffing with other members of the clinical team to review client ...
Peer Support Specialist
$15.75 - $20.25/hr
CHILD, ADOLECENT AND FAMILY SERVICESPROGRAM MANAGER STATEMENT OF JOB: This Position draws upon ... Participates in weekly clinical staffing with other members of the clinical team to review client ...
Peer Support Specialist
$15.75 - $20.25/hr
CHILD, ADOLECENT AND FAMILY SERVICESPROGRAM MANAGER STATEMENT OF JOB: This Position draws upon ... Participates in weekly clinical staffing with other members of the clinical team to review client ...
Peer Support Specialist
$15.75 - $20.25/hr
CHILD, ADOLECENT AND FAMILY SERVICES PROGRAM MANAGER STATEMENT OF JOB: This Position draws upon ... Participates in weekly clinical staffing with other members of the clinical team to review client ...
Peer Support Specialist
$15.75 - $20.25/hr
CHILD, ADOLECENT AND FAMILY SERVICES PROGRAM MANAGER STATEMENT OF JOB: This Position draws upon ... Participates in weekly clinical staffing with other members of the clinical team to review client ...
Peer Review Manager information
What is a peer review manager?
What are the key skills and qualifications needed to thrive as a peer review manager?
How does a peer review manager typically interact with authors, reviewers, and editorial boards during the publication process?
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For Peer Review Manager jobs in Arizona, the most frequently searched job titles are:
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The top searched job categories for Peer Review Manager jobs in Arizona are:
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Full-time
This job post has expired today. Applications are no longer accepted.
Job description
PURPOSE STATEMENT: Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
ResponsibilitiesESSENTIAL FUNCTIONS:
- Act as liaison between managed care organizations and the facility professional clinical staff.
- Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
- Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
- Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
- Conduct quality reviews for medical necessity and services provided.
- Facilitate peer review calls between facility and external organizations.
- Initiate and complete the formal appeal process for denied admissions or continued stay.
- Assist the admissions department with pre-certifications of care.
- Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
OTHER FUNCTIONS:
- Perform other functions and tasks as assigned.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- Required Education: High school diploma or equivalent.
- Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
- Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
- CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
- First aid may be required based on state or facility requirements.
ADDITIONAL REGULATORY REQUIREMENTS:
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.
OAS01
Employment Type: FULL_TIME