University of Wisconsin School of Medicine and Public HealthObstetrician Gynecologist - Hospitalist - ASOG Division University of Wisconsin School of Medicine and Public HealthObstetrician Gynecologist - Hospitalist - ASOG DivisionMadison, WIThe University of Wisconsin School of Medicine and Public Health Department of Obstetrics and Gynecology is seeking an obstetrician-gynecologist hospitalist in a clinical practice in the diagnosis and treatment of normal obstetrics and gynecology as well as in the disorders related to the female reproductive system. For an appointment at Clinical Associate Professor or Clinical Professor rank on CT Track, candidates will meet criteria established by the department and as outlined in the School of Medicine and Public Health guidelines for promotion or appointment to Associate or Professor on the CT Track.
TriWest Healthcare AllianceUtilization Clinical Reviewer TriWest Healthcare AllianceUtilization Clinical ReviewerMilwaukee, WIRemoteFull timeApplies clinical knowledge to make determinations for preauthorization, inpatient and continued stay reviews for Behavioral Health and Medical/Surgical requests to establish medical necessity, benefit coverage, appropriateness of quality of care, and length of stay or care plan. The Utilization Management Clinical Review nurse reviews and makes decisions about the appropriateness and level of beneficiary care being provided in an effort to provide cost effective care and ensure proper utilization of resources.
TriWest Healthcare AllianceClinical Quality Reviewer TriWest Healthcare AllianceClinical Quality ReviewerMilwaukee, WIRemoteFull timeo Bachelor's in Nursing or Certified Professional in Healthcare Quality (CPHQ) o 1 or more years team lead or supervisory experience o 1 year experience in Quality Management o 1 year experience with data analysis and reporting o Experience with InterQual or similar criteria sets o General knowledge of Medicare, Veterans Administration, or other government health care programs. Technical Skills: General knowledge of Medicare, Veterans Administration, or other government health care programs; knowledge in the application of clinical criteria: InterQual, Milliman, PAS-LOS, ICD-9-CM, DSM, CPT-4, and HCPCs; Proficient with Microsoft Word and Excel.
TriWest Healthcare AllianceClaims Reviewer TriWest Healthcare AllianceClaims ReviewerMilwaukee, WIRemoteFull timeProficient with claim and coding tools and resources, Clinical Decision Support Tool, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental coding. Provides clinical and coding-related information to medical director, providers, peer reviewers, Claims Administration, Program Integrity, Quality Management, and/or the Claims Subcontractor as needed.
TriWest Healthcare AllianceSr Claims Reviewer TriWest Healthcare AllianceSr Claims ReviewerMilwaukee, WIRemoteFull timeProficient with claim and coding tools such as Supercoder, Clinical Decision Support Tool, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental coding. This role will serve as a SME and will collaborate with Claims leadership, Training, the Claims Content Specialist, and internal business partners to ensure procedures and training materials are accurate and complete.