Clinical Peer Reviewer definition

Clinical Peer Reviewer means a physician who possesses a current and valid non-restricted license to practice medicine or a health care professional other than a licensed physician who: (1) where applicable, possesses a current and valid non-restricted license, certificate or registration or, where no provision for a license, certificate or registration exists, is credentialed by the national accrediting body appropriate to the profession, and (2) is in the same profession and same or similar specialty as the Health Care Provider who typically manages the medical condition or disease or provides the Health Care Service or treatment under review.
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Clinical Peer Reviewer means a practicing health care professional who holds a nonrestricted license in a state, district, or territory of the United States and in the same or similar specialty as typically manages the medical condition, procedure, or treatment under appeal.
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Examples of Clinical Peer Reviewer in a sentence

  • Such reconsideration shall be conducted by the attending dentist and the Clinical Peer Reviewer making the initial determination or a designated Clinical Peer Reviewer if the original Clinical Peer Reviewer cannot be available.

  • The review shall be conducted for Delta Dental by a Clinical Peer Reviewer who is neither the Clinical Peer Reviewer who made the claim denial that is the subject of the review, nor the subordinate of such individual.

  • The Directors of Quality Management review the issues with the Amida Care Chief Medical Officer and/or Clinical Peer Reviewer, as indicated.When indicated by risk of potential or further patient harm, the quality issue is immediately reported to the appropriate agencies.

  • When necessary, cases involving a potential adverse determination are reviewed by a Clinical Peer Reviewer in the same specialty of the physician proposing the treatment.

  • A Carrier or Utilization Review Organization shall give a Provider treating an Insured an opportunity to seek reconsideration of an Adverse Determination from a Clinical Peer Reviewer in any case involving an initial determination or a Concurrent Review determination.

  • All UR appeals will be conducted by Clinical Peer Reviewers other than the Clinical Peer Reviewer who rendered the initial Adverse Benefit Determination.

  • The review shall be conducted for Delta Dental by a Clinical Peer Reviewer who is neither the Clinical Peer Reviewer who made the claim denial that is the subject of the review, nor the subordinate of such individual.The review will take into account all comments, documents, records, or other information, regardless of whether such information was submitted orconsidered in the initial benefit determination.

  • The Clinical Peer Reviewer may be the Quality Improvement Supervisor, Quality Improvement Coordinator, Nurse Care Manager, Nurse Care Management Supervisor or Medical Director.

  • Decisions to overturn or modify a Clinical Peer Review decision may only be made by a Zenith Medical Officer or external Clinical Peer Reviewer.

Related to Clinical Peer Reviewer

  • Clinical peer means a physician or other health care professional who holds a non-restricted license in a state of the United States and in the same or similar specialty as typically manages the medical condition, procedure or treatment under review.

  • Peer-reviewed medical literature means a scientific study published only after having been critically

  • Peer review committee means one or more persons acting in a peer review capacity who also serve as an officer, director, trustee, agent, or member of any of the following:

  • Peer review means evaluation of professional services rendered by a professional practitioner.

  • Clinical review criteria means the written screening procedures, decision abstracts, clinical protocols, and practice guidelines used by a health carrier to determine the necessity and appropriateness of health care services.

  • Clinical evaluation means a systematic and planned process to continuously generate, collect, analyse and assess the clinical data pertaining to a device in order to verify the safety and performance, including clinical benefits, of the device when used as intended by the manufacturer;

  • Clinical nurse specialist means a registered nurse with relevant post-basic qualifications and 12 months’ experience working in the clinical area of his/her specified post-basic qualification, or a minimum of four years’ post-basic registration experience, including three years’ experience in the relevant specialist field and who satisfies the local criteria.

  • Technical Advisory Committee means a committee established under section 12;

  • independent review committee means the independent review committee of the investment fund established under National Instrument 81-107 Independent Review Committee for Investment Funds;

  • Clinical means having a significant relationship, whether real or potential, direct or indirect, to the actual rendering or outcome of dental care, the practice of dentistry, or the quality of dental care being rendered to a patient;

  • Clinical experience means providing direct services to individuals with mental illness or the provision of direct geriatric services or special education services. Experience may include supervised internships, practicums, and field experience.

  • Medical Review Officer (MRO means a licensed physician, employed with or contracted with the City, responsible for receiving laboratory results generated by the City's drug testing program who has knowledge of substance abuse disorders, laboratory testing procedures, and chain of custody collection procedures; who verifies positive, confirmed test results, and who has the necessary and appropriate medical training to interpret and evaluate an individual's confirmed positive test result together with his or her medical history and any other relevant biomedical information.

  • Screening Committee means the State level Screening Committee constituted in terms of sub-rule (2) of rule 123 of these rules.

  • Participating Certified Clinical Nurse Specialist means a Certified Clinical Nurse Specialist who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Non-Participating Certified Clinical Nurse Specialist means a Certified Clinical Nurse Specialist who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Peer support specialist means an individual who has experienced a severe and persistent mental illness and who has successfully completed standardized training to provide peer support services through the medical assistance program or the Iowa Behavioral Health Care Plan.

  • Medical Advisory Committee means the Medical Advisory Committee established by the Board as required by the Public Hospitals Act;

  • Joint Commercialization Committee or “JCC” has the meaning set forth in Section 3.4 (Joint Commercialization Committee).

  • Multiregional Modeling Working Group or “MMWG” shall mean the NERC working group that is charged with multi-regional modeling.

  • Phase 2 Clinical Trial means a human clinical trial, for which the primary endpoints include a determination of dose ranges or an indication of efficacy in patients being studied as described in 21 C.F.R. §312.21(b), or an equivalent clinical trial in a country in the Territory other than the United States.

  • District Level Anti-Ragging Committee means the Committee, headed by the District Magistrate, constituted by the State Government, for the control and elimination of ragging in institutions within the jurisdiction of the district.

  • Evaluation Team means the team appointed by the City; “Information Meeting” has the meaning set out in section 2.2;

  • Pivotal Clinical Trial means a human clinical trial in any country that is prospectively designed to generate data intended to satisfy the requirements of 21 C.F.R. § 312.21(c) (as amended) in the U.S. or a similar clinical study prescribed by a Regulatory Authority from another country, from time to time, pursuant to Applicable Law.

  • Participating Clinical Laboratory means a Clinical Laboratory which has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Over-Riding Nomination Criteria means the criteria set out in clause 4.2.

  • Reviewer means the actuary engaged to review or repeat the first actuary’s work, and