Utilization Review Clinician
WellSkyFull Time
Mid-level (3 to 4 years)
Candidates must be Board Certified (M.D. or D.O.) and hold active practice status. Maintaining proper credentialing and state licenses, along with any special certifications or requirements necessary for the job, is essential. The position requires the ability to interpret medical necessity in compliance with client policies, evidence-based guidelines, and standards of care.
The Physician Reviewer will utilize clinical expertise to review insurance appeals and claims, providing interpretations of medical necessity for services rendered by other healthcare professionals. Responsibilities include reviewing medical records, addressing client questions using specific criteria, and ensuring clear, concise rationales with adequate supporting documentation. The role involves identifying and utilizing current criteria and resources, providing copies of utilized criteria with reports, returning cases by due dates, making mandated telephone calls, and attending required orientation and training. Additionally, the reviewer will identify and respond to quality assurance issues, complaints, regulatory issues, and may be involved in depositions, court appearances, or audits.
Specialty coffee shop with efficient service
Blank Street provides a unique coffee shop experience by offering high-quality coffee and food at affordable prices. The company started with a small coffee cart in Brooklyn and has since expanded to major cities like New York, London, Boston, and Washington, D.C. Their product offerings include specialty coffees sourced from around the world and fresh, locally-sourced food. Customers can enjoy a quick yet premium experience, thanks to the efficiency of their small locations that help keep costs down. Blank Street differentiates itself from competitors by focusing on customer convenience through technology, such as their app that allows for ordering ahead, customizing drinks, and participating in loyalty programs. They also prioritize employee satisfaction by paying baristas above-market wages. The goal of Blank Street is to redefine the coffee shop experience by combining quality, affordability, and exceptional service, making it a significant player in the specialty coffee market.