Reviewer

• Conduct onsite reviews of Ohio Medicaid provider locations throughout the state.
• Travel daily to provider sites and complete assigned review schedules.
• Execute ODM-approved site review checklists and conduct provider interviews in accordance with established protocols.
• Assess provider operations, documentation practices, and regulatory compliance requirements.
• Document site visit findings accurately, thoroughly, and professionally using proper grammar, punctuation, and objective observations.
• Submit completed reviews within established quality assurance and compliance deadlines.
• Analyze collected information and provide recommendations regarding provider enrollment or continued participation in Medicaid programs.
• Maintain strict confidentiality regarding provider information, findings, and review outcomes.
• Meet established productivity, quality, and customer service performance standards.
• Work independently while effectively managing priorities, deadlines, and travel schedules.
• Address provider questions and concerns professionally and identify opportunities for process improvement.
• Utilize technology, tablets, and reporting systems to document and complete reviews.
• Represent the organization professionally during all provider interactions.

Onsite Reviewer assessing Ohio Medicaid provider operations and compliance

Onsite Reviewer

Onsite Reviewer assessing and reviewing Ohio Medicaid providers for compliance and quality assurance. Conducting in-person evaluations and documenting findings for medicaid enrollment considerations.

• Use rubrics and supplemental information to provide fair and consistent evaluations with encouraging, specific, and actionable feedback
• Maintain an in-depth knowledge of every component of curriculum within assigned workload
• Swiftly respond to student outreach and return evaluations to students within 48 hours of submission
• Work with Goal Lead to provide proactive outreach to students in need of academic assistance
• Participate in Reviewer online community
• Support academic integrity validation and processing potential violations
• Participate in quality assurance processes and project improvement activities, as needed

Reviewer evaluating student projects at Southern New Hampshire University

Reviewer responsible for evaluating student project submissions at Southern New Hampshire University. Provide actionable feedback and ensure academic integrity in evaluations.

• conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines
• collaborating with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits
• working on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management
• partnering with more senior colleagues to complete non-routine reviews
• conducting medical necessity clinical screenings of preauthorization requests to assess the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment

Nurse Reviewer 1 conducting preauthorization reviews for diagnostic imaging services

Nurse Reviewer

Nurse Reviewer 1 responsible for conducting preauthorization reviews for diagnostic imaging services. Collaborating with healthcare providers to ensure quality member outcomes and optimize benefits.

• In-person interview may be required during the hiring process
• Manage relationships with internal and external customers/vendors

MD Appraisal Reviewer managing automobile appraisals at Mercury Insurance

MD Appraisal Reviewer

MD Appraisal Reviewer managing automobile appraisals at Mercury Insurance. Collaborating with internal and external teams to ensure efficient processes and accurate valuations.

• Provide a holistic evaluation for domestic and international applications for undergraduate admission.
• Review all application materials and make an admissions recommendation based on extensive training.
• Attend and participate in monthly trainings and individual coaching sessions, and other meetings as needed during normal university business hours.
• Enter recommendations for completed reviews into the review site on a weekly basis.
• Ensure confidentiality and security of the admissions process, files, and university materials.

Seasonal Application Reviewer evaluating undergraduate applications at The Ohio State University

Seasonal Application Reviewer

Seasonal Application Reviewer conducting holistic evaluations for undergraduate applications at The Ohio State University. Responsibilities include reviewing materials, making recommendations, and attending training sessions for the admissions process.

• Responsible for utilization review calls within BHS, including precertification, continued stay review, discharge reviews, and retrospective reviews and appeals.
• Works closely with business office staff, clinical staff, and physicians to advocate for BHS patients with insurance and managed care companies.
• Communicates insurance input to physicians and clinical staff making discharge plans for patients.
• Assists clinical staff with assessments as needed, primarily as in a back-up capacity.
• Communicates daily with Utilization Review Coordinator, and as needed with business office and admissions staff to understand admissions and transfers, patient benefit information, and precertification status.
• Understands health care benefit plan provisions and managed care contracting.
• Communicates and coordinates efforts at appealing unfavorable utilization review decisions.

Utilization Reviewer managing behavioral health utilization within Northwestern Medicine

Utilization Reviewer, Behavioral Health

Utilization Reviewer managing behavioral health utilization reviews at Northwestern Medicine. Focused on precertification, discharge reviews, and advocating for patients with insurance companies.

• Conduct comprehensive research in county records to determine mineral ownership, utilizing online databases or visiting local county courthouses as needed.
• Maintain clear and professional communication with both internal team members and external stakeholders.
• Analyze and document research findings, extracting pertinent information for client reports.
• Manage multiple priorities and meet deadlines in a dynamic environment with shifting timelines.
• Assist with additional tasks and responsibilities as management assigns, based on evolving business needs.
• Review the work of other landmen, providing constructive feedback to ensure accuracy and consistency in all research and documentation.

Landman Reviewer supporting project management efforts at Purple Land Management

Landman Reviewer

Landman Reviewer supporting project management efforts at Purple Land Management. Responsible for title research and providing feedback to fellow landmen while ensuring accuracy and consistency.

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