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include the following. Other duties may be assigned Utilizes leads provided by the team and referrals from government and private agencies, works with the team to prioritize complaints for investigation, and then investigates, conducts interviews and reviews information to make potential fraud determination. Determines investigation or case appropriateness of fraud, waste and abuse issues in accor
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include the following. Other duties may be assigned. Creates statistical approaches and analyze data generated by multiple providers or from various review processes (e.g., identifying benchmarks or care, peer groups, and stratification). Trends data to understand opportunities for improvement or focused investigation. Develops statistically sound designs for quality improvement projects implement
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System and process analysis with evaluation and recommendations to increase performance. Collaborates with the customer to design and adapt processes and deliverables to meet changing needs. Utilizes measurement systems to evaluate performance and improvement. Identifies opportunities for improvement; assists teams in developing and implementing improvement strategies. Supervisory Responsibilities
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System and process analysis with evaluation and recommendations to increase performance. Collaborates with the customer to design and adapt processes and deliverables to meet changing needs. Utilizes measurement systems to evaluate performance and improvement. Identifies opportunities for improvement; assists teams in developing and implementing improvement strategies. Supervisory Responsibilities
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While medical review and support of review determinations will be the primary responsibilities of this position, the Medical Director job description includes the following essential duties and responsibilities. Other duties may be assigned. Provides clinical information to teams Medical Review Oversight may include Physician peer review activities Criteria development and assessment Correspondenc
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Medical Director Mississippi Hospice Medical Review Contract Job Location Jackson, MS Position Type Full Time/Regular Qlarant is a not for profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care o
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Medical Director ID Hospice Medical Review Contract Job Location Boise, ID Position Type Full Time/Regular Qlarant is a not for profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization
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Medical Review Nurse Medicare/Medicaid Audit Job Location Cerritos, CA Position Type Full Time/Regular Qlarant, Inc., is a not for profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We're a national leader in fighting fraud, waste and abuse for large organizations across the country. Qla
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Medical Review Nurse Medicare/Medicaid Audit Job Location Chicago, IL Position Type Full Time/Regular Qlarant, Inc., is a not for profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We're a national leader in fighting fraud, waste and abuse for large organizations across the country. Qlar
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While medical review and support of review determinations are the primary responsibilities, this position also includes the following essential duties and responsibilities. Other duties may be assigned. Provides clinical information to teams Medical Review responsibilities may include Physician peer reviews Supporting determinations during appeal process, including depositions and other testimony
Posted Today
While medical review and support of review determinations are the primary responsibilities, this position also includes the following essential duties and responsibilities. Other duties may be assigned. Provides clinical information to teams Medical Review responsibilities may include Physician peer reviews Supporting determinations during appeal process, including depositions and other testimony
Posted Today
Trend data to identify potential opportunities (e.g., variances, significant outliers, percentile ranked groups) for quality improvement or focused investigations. Design data analysis strategies to identify potential areas for quality improvement or focused investigation. Develop epidemiological sound indicators of the quality of care. Analyst data and summarize into quality indicator values Iden
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Trend data to identify potential opportunities (e.g., variances, significant outliers, percentile ranked groups) for quality improvement or focused investigations. Design data analysis strategies to identify potential areas for quality improvement or focused investigation. Develop epidemiological sound indicators of the quality of care. Analyst data and summarize into quality indicator values Iden
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Interventional Cardiologist Contract Home based Job Location Dallas, TX Position Type Consulting Qlarant is a not for profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality r
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include the following. Other duties may be assigned. Manages the day to day operations of assigned projects, as well as inter project and cross setting coordination of resources among projects; and contracts including facilitation and communication of resolution of barriers. Prioritizes, delegates, and accomplishes tasks and programs independently and in a team to ensure successful implementation
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