Quality Assurance, Utilization Review, or Case Management

REVIEWER MEDICAL NECESSITY - Portland, OR: Description: Resolves, audits, and processes claims for clinically related issues to ensure accuracy of claims payment, in coordination with the Claims Administration Department.Essential Functions:- Responsible for reviewing, processing, and auditing claims for payment and appropriateness of charges and pursues adjustments as warranted.- Screens, audits, and processes claims of specific criteria for appropriate payment.- Establishes ...
Reference Code: 180527
Medical Safety Coordinator - Clackamas, OR: Description: Develop, implement, coordinate, integrate, and monitor emergency management programs and practices at Kaiser Sunnyside Medical Center (KSMC) in order to provide a safe environment for patients, staff, and visitors. Educate, train, and monitor performance necessary to assure ongoing compliance with Federal, State, and Local regulatory requirements and accreditation standards.Essential Functions:- Develop, implement, coordi...
Reference Code: 184253