- Humana (Washington, DC)
- **Become a part of our caring community and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure that ... rendered is complete, compliant and accurate to support optimal reimbursement. The Nurse Auditor 2 work assignments are varied and frequently require… more
- MD Anderson Cancer Center (Houston, TX)
- …audits of patient accounts to complete Defense Audits. *Ideal Candidate:* A *Registered Nurse (RN)* with experience in *appeals* and * nurse auditing*. *Key ... insurance appeals, prior case management or business office experience and nurse audit experience. *Work Schedule*: This position is remote. Prefer Houston/local… more
- Northwell Health (Glen Cove, NY)
- …related experience. 2 .Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed. 3. ... 1.Leverages clinical expertise to identify and validate DRG code assignment. 2 .Full review of CDI suggested code changes 3.Demonstrates comprehensive knowledge of… more
- Trinity Health (Livonia, MI)
- …and utilization management. + Customer service background is required. **Preferred:** + Registered Nurse + Bachelor's degree + Two plus ( 2 +) years of charge ... audit, managed care or comparable patient payment processing experience preferred. + AAPC,AHIMA, CHRI certification/membership. + Outpatient CDI experience. + Working knowledge of Electronic Health Records (EHR). **Our Commitment** Rooted in our Mission and… more
- Northwell Health (Westbury, NY)
- …Degree in Nursing, preferred. Must be enrolled in an accredited BSN program within two ( 2 ) years and obtain a BSN Degree within five (5) years of job entry date. ... + Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed. *Additional Salary Detail The… more
- Robert Half Accountemps (Boston, MA)
- Description Job Title: Medical Claims Auditor - RN Auditor Location: Massachusetts - 90% Remote Job Type: 1 Year Contract - Potential for Perm Hire Hours: 40 ... Start Date: December 1, 2025 Job Description We are seeking a qualified Auditor with healthcare experience to support Program Integrity activities for a state… more
- Insight Global (South Jordan, UT)
- Job Description Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100% remote. This person should have an extensive background in ... and coding terminology. Expert coding knowledge (DRG & ICD-10) Registered Nurse RN (must be inpatient) WITH coding/clinical documentation certification ( 2… more
- UNC Health Care (Chapel Hill, NC)
- …the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides elbow to elbow support during training and education as well as ... accuracy and recommends education and training related to results. 2 . Monitor and provide feedback to new-hire CDS, as...(American Academy of Professional Coders) certification - RN (Registered Nurse ) license - LPN (Licensed Practical Nurse )… more
- AdventHealth (Orlando, FL)
- …role you'll contribute:** The Clinical Documentation Integrity Manager is a Registered Nurse and/or a Registered Health Information Administrator with a high level ... Additional Licenses and Certifications Current active State license as a Registered Nurse , Nurse Practitioner, Physicians Assistant, Medical Physician, or an… more
- Henry Ford Health System (Detroit, MI)
- …electronic medical records for accuracy of implants, surgical and recovery time stamps. 2 . Provides investigation of all charges for accuracy of the EPIC charting ... graduation from an accredited school of nursing. * Two ( 2 ) years of Cath lab experience to gain clinical...Interventional (VI) or license to practice as a registered nurse in the state of Michigan. * BLS/ACLS. Additional… more
- Molina Healthcare (Bronx, NY)
- …and works collaboratively to subsequently resolve/correct. Required Qualifications * At least 2 years health care experience, with at least 1 year experience in ... managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in state of practice.… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, Geriatrics, etc.) to ensure continuity and ... NYS DOH, CMS, NCQA, and HEDIS, serving as internal auditor within the group. + Responsible for all aspects...addition to Level I Qualifications) + A minimum of 2 years in case management position. + Case Management… more
- Baystate Health (Springfield, MA)
- …MA.** **SCHEDULE:** + Part time, 24 hours/week, 1st Shift + Hours: 7am-7:30pm + 2 shifts per week, rotating days and weekends required **LOCATION** : + Baystate Main ... needs of all communities in need. **QUALIFICATIONS:** + HS Diploma/GED + 1- 2 years experience in customer service (healthcare setting preferred) + Medical… more
- Baystate Health (Springfield, MA)
- …MA.** **SCHEDULE:** + Part time, 24 hours/week, 3rd Shift + Hours: 7pm-7:30am + 2 shifts per week, rotating days and weekends required **LOCATION** : + Baystate Main ... needs of all communities in need. **QUALIFICATIONS:** + HS Diploma/GED + 1- 2 years experience in customer service (healthcare setting preferred) + Medical… more
- Baystate Health (Springfield, MA)
- …in need. **QUALIFICATIONS:** + Prior administrative experience strongly preferred + 1- 2 years' experience in customer service (healthcare setting preferred) + ... be applicable to this role.** **Summary:** Reports to the Nurse Manager but daily activities are coordinated by the...breaks and meals to ensure constant flow of ADTs. ** 2 )** Proficiently and accurately utilizes the following computer applications… more
- Corewell Health (Grand Rapids, MI)
- …relevant experience: + Legal or regulatory field; health care focus desirable + Compliance auditor , nurse auditor , or other audit function + Project ... This is a hybrid position. The onsite requirement is 2 days per week but can fluctuate based on...area, or equivalent combination of education and experience + 2 years of relevant skills, knowledge, abilities typically gained… more
- Molina Healthcare (IA)
- …or equivalent experience, OR completion of any of the following programs: + Registered Nurse (RN) or State Licensed Vocational Nurse (LVN), or + Registered ... Min. 4 years experience in healthcare Quality/HEDIS projects/audits * 2 + years of experience in HEDIS medical records collection...completion of any of the following programs: + Registered Nurse (RN) or State Licensed Vocational Nurse … more
- BJC HealthCare (St. Louis, MO)
- …collaborating within a team setting? BJC Home Care is looking for an licensed practical nurse Scheduler, auditor and field visits to assist our patients and our ... 8:00 am - 4:30 pm Weekends: as determined Holidays: 2 per year _*Position requires registration with the Family...within the scope of practice for the Licensed Practical Nurse . + Under the direction of the Registered … more
- HCA Healthcare (San Antonio, TX)
- …true discrepancy and complete incident reports as required. You will review RX Auditor report and generate investigation reports for nurse managers/directors to ... course sponsored by an ACPE accredited provider. + Minimum 2 years of hospital experience required + Minimum 1...private patient rooms and eight VIP rooms with private nurse stations, Methodist Hospital | Landmark delivers a true… more
- NCH (Naples, FL)
- …Specialist for educational opportunities/outcomes. * Collaborates with CDI liaison/quality auditor when educational needs are identified from second level reviews. ... required; Bachelor's Degree preferred. * Licensed as a Registered Nurse in the state of Florida. * 5+ years...or previous CDI experience in an academic institution with 2 + years of leadership experience. * Team leading experience… more