Job Description

Identify cases eligible for medical reviews and assign these to appropriate reviewers.

Reach out to the client for any problems identified in the cases for review.

Adhere to Utilization Review Accreditation Commission (URAC), jurisdictional, and/or established MediCall best practice UM time frames, as appropriate.

Adhere to federal, state, URAC, client, and established MediCall best practice WCUM time frames, as appropriate.

Develop a complete understanding of the Medical management Procedures.

Perform medical review assessment (MRA) on utilization of health services (eg healthcare plans, workers compensation products etc) in an accurate, efficient and timely manner while ensuring compliance with utilization management regulations and adherence to state and federal mandates.

Provide succinct negotiable points based on the submitted medical records that identify necessary medical treatment, casually related care, response or lack of response to treatment, etc.

Identify missing records and information that are necessary in the completion of the medical review assessment.

Adhere to Department of Labor, state and company timeframe requirements.

Coordinates physician reviewer referral as needed and follows up timely to obtain and deliver those results.

Track status of all utilization management reviews in progress and follow up on all pending cases.

Work closely with management team in the ongoing development and implementation of utilization management programs.

Respond to inbound telephone calls pertaining to medical reviews in a timely manner, following client a established protocols.

Process customer calls consistent with program specified strategies and customer satisfaction measurements to include but not limited to proper answering procedure, eg opening and closing remarks.

Learn new methods and services as the job requires.

Ct:

HR KAMATCHI

  • Experience

    0 - 1 Years

  • No. of Openings

    50

  • Education

    BDS, BAMS, B.Pharma, B.E, BVSC, M.Pharma, M.Sc, M.Tech

  • Role

    Dentist

  • Industry Type

    Hospitals / Medical / Healthcare Equipments

  • Gender

    [ Male / Female ]

  • Job Country

    India

  • Type of Job

    Full Time

  • Work Location Type

    Work from Office

About Achievers Spot

Achievers Spot is a leader in providing Medical Coding training and placement services in Chennai. We are counted as building a platform where people can come and explore exciting and lucrative careers. We have team of dedicated Trainers and consultants with hands-on experience in healthcare field.
Read More...
Similar Jobs
Apply Now

Register to Get Relevant Jobs

Get Noticed By Top Recruiters

Become a Premium Job Seeker

  • Higher Boosting
  • Resume Highlighter
  • Verified Stamp
  • Resume Exposure

499/- for 3 months

Pay Now

Similar Jobs

Urgent Opening For Prosthodontist

Yash Dental Clinic

  • Experience 3 - 4 yrs
  • Salary 12.0 Lac/Yr
ProsthodontistDentist

Dentist

Dr Vetri Vendan Dental Care

  • Location Chennai
  • Experience 1 - 4 yrs
  • Salary 2.3 Lac/Yr
BDSRestorationPatient Care

Dental Assistant (Female)

Manis Dental Care

  • Location Saravanampatti Coimbatore
  • Experience 0 - 2 yrs
English LanguageReceptionist Activities

Female - Endo Senior Lecturer Wanted For A Dental College in South India

Medident Jobs

  • Experience 0 - 2 yrs
  • Salary 6.5 Lac/Yr
Communication SkillsRCTFillingTeaching Staff

Hiring For Dentists

Yash Dental Clinic

  • Experience 1 - 3 yrs
  • Salary 7.0 Lac/Yr
Dentistry-Oral SurgeryGeneral Dentist

Wanted Dentist Freshers

Achievers Spot

  • Experience 0 - 1 yrs
  • Salary 4.0 Lac/Yr
NanotechnologyOperations AnalystOperation Theatre TechnicianVeterinary NurseOperation TheatreMedical CodingMedical CoderHome ScienceEnvironment ExecutiveOptometristMedical Coding TraineeMedical Coding FreshersBDSBhmsBvsc

Opening For Dental Technician

Ortho Dent Lab

  • Location Around Chennai
  • Experience 0 - 1 yrs
  • Salary 2.3 Lac/Yr
Visual Basic

Medical Coding Training With JOB -Science Graduates,BDS,BSc,BPh,MSC,MPh

SSZ Infotech

  • Experience 0 - 6 yrs
  • Salary 3.3 Lac/Yr
Basic Computer SkillsMedical LAB TechnicianParamedical TechnicianGeneral Dentist

Dental Surgeon (Female Candidates Required)

Dr Balaji B Dental Clinic

  • Location Chennai
  • Experience 1 - 3 yrs
  • Salary 2.3 Lac/Yr
Root Canal Treatment

General Dentist (female)

Career Land Center

  • Experience 3 - 9 yrs
  • Salary 45.0 Lac/Yr
General Dentist

Endodontist Wanted For Dental College South/central India

Medident Jobs

  • Experience 0 - 5 yrs
  • Salary 6.0 Lac/Yr
RCTDental TeacherDental DoctorEndodontistWalk in

Dental Insurance Verification Specialist

Nibodhah

  • Experience 1 - 2 yrs
  • Salary 3.5 Lac/Yr
OmsPmsDental VerificationWinInsurance VerificationWork From Home

General Dentist

Yash Dental Clinic

  • Experience 3 - 4 yrs
  • Salary 3.8 Lac/Yr
Root Canal TreatmentDental SurgeonGeneral DentistOrthodontist

BDM Sales Dental Implants Manager Ambala,Chennai & Hyderabad

Capital Placement Services

  • Experience 2 - 8 yrs
  • Salary 7.0 Lac/Yr
Dental ImplantImplant SalesDental EquipmentB2b SalesBDMBusiness Development ManagerSales ManagerDentalMaleMedical EquipmentWalk in

Urgent Hiring Dentist For Arumbakkam

Bridge Placements

  • Location Arumbakkam Chennai
  • Experience 1 - 6 yrs
AestheticCosmetologyDentist

Related Job Openings

We use cookies to improve your experience. By continuing to browse the site, you agree to our Privacy Policy Terms & Conditions [Seeker]

Got it