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.
CVS Health CorpPrior Authorization Clinical Reviewer CVS Health CorpPrior Authorization Clinical ReviewerWI$26.01–$74.78 / yearApplication of critical thinking and knowledge of clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services for members with disabilities and special healthcare needs. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
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.
Thermo Fisher Scientific IncNewSenior Data Reviewer (GMP Lab, Biopharmaceutical) Thermo Fisher Scientific IncSenior Data Reviewer (GMP Lab, Biopharmaceutical)Middleton, WIRemoteAs one team of 100,000+ colleagues, we share a common set of values - Integrity, Intensity, Innovation and Involvement - working together to accelerate research, solve complex scientific challenges, drive technological innovation and support patients in need. With clinical trials conducted in 100+ countries and ongoing development of novel frameworks for clinical research through our PPD clinical research portfolio, our work spans laboratory, digital and decentralized clinical trial services.
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.
Medica Health Plans IncSupervisor, Clinical Quality Review Medica Health Plans IncSupervisor, Clinical Quality ReviewMadison, WI$78,700–$118,020 / yearTranslates regulatory and coding requirements into practical guidance for internal teams and external partners Serves as a clinical subject matter resource during internal, vendor, or provider discussions Assists Director and Manager as needed to develop, introduce and support overall goals Develops linkages with specific departments on behalf of the Clinical Review area such as Data Management, Legal, Network Management, Compliance, Pharmacy and Complementary Networks. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the positions scope and responsibility, internal pay equity and external market salary data.
Elevance Health IncNewNurse Care Manager I Elevance Health IncNurse Care Manager IWaukesha, WIRequires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred or any combination of education and experience, which would provide an equivalent background, Multi-state licensure is required if this individual is providing services in multiple states. The Nurse Care Manager I will be responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.
Froedtert & The Medical College of WisconsinRN CLIN DOCUMENT SPEC QUALITY- ENTERPRISE QUALITY CDI/UR/DM Froedtert & The Medical College of WisconsinRN CLIN DOCUMENT SPEC QUALITY- ENTERPRISE QUALITY CDI/UR/DMMILWAUKEE, WI$38.92–$60.33 / hourJob Summary: The RN Second-Level CDI & Quality Reviewer is a senior-level clinical documentation professional responsible for performing in-depth, concurrent and retrospective reviews of medical records to ensure accurate documentation that supports correct Diagnosis-Related Group (DRG) assignment and other quality-based outcomes. In addition to validating query appropriateness and documentation practices, this role analyzes Patient Safety Indicators (PSIs), Hospital-Acquired Conditions (HACs), and other publicly reported hospital quality metrics.
Network Health LLCNewRN Coordinator Utilization Management Network Health LLCRN Coordinator Utilization ManagementMenasha, WIComplete assessments and plans of care including need for medication regime, treatment plans, practitioner follow-up appointments, knowledge of red flags, disease management, Advance Directives, life planning, and self-management of illness to the best of member ability. Refer all members with complex health problems and needs to Network Health Case Management to reduce medical costs while providing a higher quality of life and an ability to take charge of their diseases.