This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Dane Street is expanding our physician panel! This is a telework opportunity for supplemental income for physicians providing a caseload customized to your schedule. Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case basis. As a Physician Reviewer/Advisor for Disability Peer Review, you will utilize clinical expertise to review medical records provided and return an independent, professional opinion on the claimant’s functionality and restrictions or limitations as it relates to an application for disability benefits or the current status of disability. Determinations are based on the clinical evidence within the medical records provided. - On a contract basis, as individual schedule permits, accepts cases, reviews all medical records, and addresses each question posed utilizing client-specific criteria or other nationally recognized evidence-based criteria, and opines on disability status. - Ensures a clear rationale for the determination that is concise and contains adequate supporting documentation to substantiate the decision. - Identifies and employs current criteria and resources, such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews; refrains from using case studies, cohorts, and the like to make decisions. - Provides a report and copies of any criteria utilized within the review promptly. - Returns cases on or before the due date and time specified. - Completes peer-to-peer calls/call attempts as required based on client-specific protocol with the goal of obtaining information not included in medical records as well as any necessary clarification. - Performs other duties as assigned, including addressing any necessary clarification, providing addendum as required (with additional compensation), identifying and responding to potential quality assurance issues, complaints, and regulatory issues. Qualifications - US Board certification required. - Active practice preferred. Benefits - Robust opportunity for supplemental income. - Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability. - No doctor/patient relationship is established, and no treatment is provided. These are advisory-only opinions. - Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise. - Expanded credentials as an expert in Independent Medical Exams and physician advisor services. - Fully prepped cases, streamlined case flow, transcription services at no cost, and a user-friendly work portal. - Dane Street supports all referral processes, scheduling, preps cases extensively, prepares all medical records, provides transcription services as applicable, facilitates all client communications, and ensures the quality and timeliness of all reports and report delivery.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Utilization Management Coordinator is responsible for supporting clinical, management, and client activities, comprising the UM Program. The Utilization Management Coordinator must be proficient in all UM processes such as: - Pre-authorizations - Claim reviews - Practitioner outreach calls - Grievance and appeals - Triage and case assignments Key responsibilities include: - Process documents through UM systems: CareRadius, CareAfiliate, RightFax, and Orion. - Track initial/concurrent service authorizations, denials, authorization gaps, and appeals status. - Manage and process case assignments for Clinical Peer Reviewers and Clinical Staff. - Process practitioner pre-authorization requests while adhering to administrative guidelines, policies, and procedures. - Monitor turnaround time of tasks to meet regulatory requirements as well as specific state and federal requirements. - Maintain a high level of accuracy when processing letters in coordination with clinical peer reviewers. - Coordinate letter QA with clinical peer reviewers to meet turnaround time requirements. - Maintain understanding of business rules and regulatory requirements pertaining to UM processes and operations. - Support departmental initiatives such as policy/procedure review, audit preparation, and work instruction updates. - Assist with monitoring client escalation mailboxes and responding to requests in a timely manner. - Conduct or support UM system testing (as needed). - Self-assign and complete tasks as they appear in assigned buckets in CareRadius and Orion. - Assist in processing Grievances and Appeals (as needed). - Other duties as assigned. Qualifications - High school diploma/GED required. - One or more years’ experience in a health care related field, preferably in managed care or utilization review. - Ability to read, analyze and interpret documents such as company policies, procedures, and operating instructions. - Ability to write routine correspondence. - Ability to solve practical problems and deal with variables. - Ability to interpret various instructions furnished in written, oral, schedule, or electronic form. - Ability to prioritize to meet deadlines and required turnaround times. - Ability to use computer software, including email, word processing, and spreadsheets. - Experience using CareRadius, CareAfiliate, RightFax, Orion is a plus. - Must exhibit strong interpersonal skills and professionalism. - Strong verbal, telephonic, and written communication skills are required. - Ability to work under pressure; must have strong listening skills. - Ability to build relationships with internal/external customers. - Ability to work with practitioners and office managers in an educational and problem-solving role. - Ability to work remotely in a dedicated workspace with a door to protect company data and PHI. - Must have high-speed internet. - Ability to support team goals and initiatives. - Must be collaborative with team members while operating in a fast-paced regulatory environment. Requirements - This is a part-time role, 20 hours per week, working Monday-Friday 1p to 5p Eastern time. - The hourly wage for this opportunity is $17.00 to $22.00. Compensation depends on several factors: qualifications, skills, competencies, and experience. Benefits - Competitive salary - Company bonus potential - Medical, dental, vision - 401k with match - Generous paid time off - Free gym membership to over 13,000 fitness locations in the US - Other great benefits Company Description Tivity Health, Inc. is a leading provider of healthy life-changing solutions, including SilverSneakers®, ForeverFit®, and WholeHealth Living®. We help adults improve their health and support them on life's journey by providing access to in-person and virtual physical activity, social and mental enrichment programs, as well as a full suite of physical medicine and integrative health services. Our suite of services support health plans, employers, health systems, and providers nationwide as they seek to reduce costs and improve health outcomes.

Role Description We are seeking an experienced Medical Reviewer with expertise in Signal Detection to play a critical role in pharmacovigilance operations, ensuring the ongoing safety and regulatory compliance of pharmaceutical products. The ideal candidate will be responsible for: - Medical evaluation of Individual Case Safety Reports (ICSRs) - Identification and assessment of safety signals - Proactive risk evaluation using advanced safety databases and statistical tools - Contributing to key safety deliverables such as PSURs, PBRERs, DSURs, and Risk Management Plans - Supporting safety governance, regulatory submissions, and audits This position is essential in safeguarding patient safety and maintaining the integrity of product safety profiles in a dynamic, global environment. Qualifications - MBBS (Required) - Postgraduate qualification in Pharmacology, Clinical Research, or Drug Safety (Preferred) - 5+ years of hands-on experience as a Medical Reviewer with demonstrated expertise in signal detection and evaluation - Strong knowledge of pharmacovigilance processes and signal detection methodologies - Proficiency with safety databases (Argus, ArisG, Veeva Safety, etc.) - Experience with disproportionality analysis and signal detection tools (e.g., Empirica Signal) - In-depth understanding of global PV regulations (ICH E2E, E2D, GVP Modules) - Proven clinical evaluation and medical writing skills - Excellent analytical, communication, and decision-making abilities - Strong presentation and interpersonal skills - Effective intercultural communication and collaboration abilities - Commitment to timely task completion, accurate documentation, and adherence to deadlines - Demonstrated problem-solving and critical thinking skills Requirements - Location: Mumbai, Maharashtra, India - Mode of Work: Remote - Department: Pharmacovigilance / Drug Safety - Qualification: MBBS - Must Have Hands-On Experience as a Medical Reviewer with Signal Detection Experience - Experience Required: 5+ years as a Medical Reviewer - Notice Period: Any - Employment Type: Full Time - Salary Range: Based on your Previous CTC

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Clinical Pharmacist (Prior Authorization) is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, DIS, and formulary management. - Researches and synthesizes detailed clinical data related to pharmaceuticals. - Prepares and presents therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee. - May review and approve or deny coverage for pharmaceuticals based on medical necessity criteria. - Coordinates with internal stakeholders or health plan medical directors as needed. - Serves as a clinical resource to other pharmacists on areas such as prospective, inpatient, and retrospective DURs. - Provides dosage conversion and clinical support for therapeutic interventions. - Prepares information for network physicians. Qualifications - Requires BA/BS in Pharmacy. - Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience. - Requires a registered pharmacist. - Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh). - For associates working within Puerto Rico, a current PR health certificate and a current PR Law 300 certificate are required. Requirements - Possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh) in Indiana. - PharmD strongly preferred. - Must be located in a state or territory of the United States when conducting utilization review or appeals consideration. - For URAC accredited areas, expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Benefits - Market-competitive total rewards including merit increases. - Paid holidays and Paid Time Off. - Incentive bonus programs (unless covered by a collective bargaining agreement). - Medical, dental, and vision benefits. - Short and long-term disability benefits. - 401(k) + match. - Stock purchase plan. - Life insurance. - Wellness programs and financial education resources.