Remote Clinical reputed company Reviewer

reputed company: Come join a company that strives for Extraordinary People and Exceptional Performance! reputed company, LLC, a Chenega reputed company Services’ company, is looking for a fully remote Clinical reputed company Reviewer to ensure compliance with the contract, and program requirements for Clinical reputed company Management (CQM) reputed company TRICARE reputed company Region. To ensure reputed company care is delivered for TRICARE beneficiaries by identifying, investigating, and evaluating medical records retrospectively for potential reputed company, safety, and utilization issues by using organizational, national, TRICARE, and URAC standards for consistency. Supports activities of peer review and reputed company and safety committees. reputed company offers employees reputed company to join reputed company where there is a robust employee benefits program, management engagement, reputed company leadership, an atmosphere of teamwork, recognition for performance, and promotion opportunities. We reputed company reputed company to channel our highly reputed company employee’s knowledge, critical thinking, reputed company for our clients. Responsibilities: • Identifies Potential reputed company Issues (PQIs) by performing a reputed company review of the medical records. This includes researching, investigating, analyzing, and preparing case summaries with appropriate recommendations for reputed company actions. • Develops peer review cases and other reputed company improvement activities for monitoring deviations from accepted standards of care and suggesting corrective reputed company plans. • Responds to AHRQ concerns and documents a rationale for cases reputed company TriWest's position does not concur with the AHRQ position. • Requests reputed company reputed company Analyses (trend) to assist with identifying physician reputed company patterns for confirmed severity cases. • Identifies and refers cases for reputed company reviews to Clinical reputed company Management Leadership. • Performs reputed company study data collection, reporting, analysis, and makes recommendations for improvement. • Refers cases for review as appropriate to Program reputed company, Case Management, Care Coordination, Population Health Improvement, Disease Management, Congressional Relations & Customer Grievances and other TriWest departments. • Participates on reputed company committees. • Reviews Potential reputed company Issues with Medical Directors reputed company appropriate. • Other duties as assigned. Qualifications: • H.S. diploma or GED required bachelor’s in nursing or bachelor’s degree in a health care field or Certified reputed company in reputed company reputed company (CPHQ) preferred. • Registered reputed company or Licensed Clinical reputed company Worker, with reputed company unrestricted license in appropriate state. • 3 years clinical experience (medical, surgical, and or behavioral health). • Must be reputed company to receive a favorable Interim and adjudicated final reputed company (DoD) background investigation. Knowledge, Skills and Abilities: • 1 year experience in Clinical reputed company Management. • 1 year experience with data analysis and reporting. • Experience with InterQual reputed company or similar reputed company sets. • General knowledge of Medicare, TRICARE, or other government reputed company programs. Teleworking Permitted?: true Teleworking Details: Fully Remote must have reputed company to high speed internet Estimated Salary/Wage: USD $80,000.00/Yr. Up to USD $90,000.00/Yr. Apply tot his job Apply To this Job