Clinical Peer Reviewer Job at Advantage Health Centers, Detroit, MI

ZXE0K213NzJhbGJ5TmtZQ2lxb2p4VGxKNnc9PQ==
  • Advantage Health Centers
  • Detroit, MI

Job Description

Summary Description

Reviews patient information to ensure treatment/service provided falls within the plan guidelines and that the service was appropriate for the condition. Reviewing for positions – Physicians – (OB/GYN, Internal Medicine, Family Medicine), Physician Assistant, Nurse Practitioner

Specific Responsibilities include, but are not limited to:

  • Reviewing x-rays, patient charts and other patient records to ensure treatment/service provided is within guidelines of the plan.
  • Review pre-authorization paperwork to ensure the intended treatment meets the treatment plan criteria and relevant program criteria.
  • Complete Peer Review Form for each chart reviewed

The list of responsibilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary, if needed.

Academic and Experience Requirements

  • Graduation from an accredited school
  • Valid, unexpired license to practice in Michigan (Physicians)
  • Valid, unexpired certification to practice in Michigan (Physician Assistant, Nurse Practitioner)
  • Successful completion /passing of background check, drug screen and credential check

Other Qualifications Desired:

  • Ability to communicate effectively (verbal and written).
  • Excellent organization and interpersonal skills required.
  • Skilled in working with others in a team environment.
  • Must be proficient in MS Office applications (Word, Excel, PowerPoint)
  • Experience working with EMR systems- eCW preferred. Will train.

Experience

  • Minimum 3-5 years of experience as a Physician, Physician Assistant or Nurse Practitioner
  • Knowledge of medical/clinical procedures, terminology, and codes.

Job Tags

Similar Jobs

Express Employment Professionals - Rochester, Troy & Clinton...

CNC Machinists & Operators | Multiple Shifts Available! Job at Express Employment Professionals - Rochester, Troy & Clinton...

 ...or Android Build a career with a company that values your experience and helps you grow. Positions are filling fastreach out today. Express Employment Professionals Rochester Hills, MI Skilled Trades | Light Industrial | Administrative | Professional... 

Eastridge

Public Affairs Administrative Assistant Job at Eastridge

 ...Public Affairs Administrative Assistant Exciting Career Opportunity! Eastridge Workforce Solutions is seeking a Public Affairs Administrative Assistant for our client in Lincolnshire, IL. This is an opportunity to work with a global leader in consumer electronics.... 

Phoebe Ministries

Paid CNA Training Program Job at Phoebe Ministries

 ...Vision, and Life Insurance. #&##128176; Competitive Pay Earn rewarding pay for your skills and flexibility!#&##128218; Tuition Reimbursement Advance your career with our support. #&##128338; Generous Paid Annual Leave PLUS the ability to sell back unused... 

Equitable Advisors

Entry Level Wealth Management Associate Job at Equitable Advisors

 ...designed to help accelerate your success as a Wealth Management Associate. After completing the necessary requirements of a Equitable...  ...consistent with branch and company strategy Demonstrates a high level of proficiency in their role as a Financial Professional.... 

Nexgen Growth Consulting

Virtual Data Entry Assistant (100% Remote) Job at Nexgen Growth Consulting

Job Type: Full-Time/Part-Time Location: Remote (Work From Home) Job Overview: We are looking for a detail-oriented and organized professional to join our remote team with a focus on customer support. This role involves managing data, handling scheduling tasks...