- UPMC (Pittsburgh, PA)
- …Maintain or exceed designated quality and production goals. Maintain employee/insured confidentiality. + Registered Nurse ( RN ). + Bachelor of Science in ... **UPMC Health Plan is looking for an Intermediate Clinical Auditor /Analyst to join the Quality...CCA, CCS, CCS-P, CRC) or AHFI designation required. + Registered Nurse ( RN ) *Current licensure… more
- Magellan Health Services (Albuquerque, NM)
- …MFT - Marriage and Family Therapist - Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care Mgmt ... Project management skills and demonstrated experience. General Job Information Title CISC Clinical Auditor Grade 25 Work Experience - Required Clinical… more
- Vatica Health (Atlanta, GA)
- …companies. We are always looking for great people to join our diverse team. The RN Clinical Coder- Nurse Auditor will independently review cases, ensuring ... + Must have a minimum of 3 years of clinical experience as a Registered Nurse ( RN ) or Licensed Practical Nurse (LPN) + Prefer incumbent to have… more
- UNC Health Care (Chapel Hill, NC)
- …Association) certification - AAPC (American Academy of Professional Coders) certification - RN ( Registered Nurse ) license - LPN (Licensed Practical ... across the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides elbow to elbow support during training and education… more
- Healthfirst (TX)
- …revising audit tools to ensure audits and reports are value-added + Applies clinical and critical thinking skills to evaluate the quality and effectiveness of case ... review decision-making + Additional duties as assigned **Minimum Qualifications:** + LPN, NYS RN license. + In order to access the Uniform Assessment System (UAS),… more
- Molina Healthcare (Dallas, TX)
- **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management ... Management (HM), and/or Disease Management (DM). + Monitors key clinical staff for compliance with NCQA, CMS, State and...them. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and… more
- Centene Corporation (Phoenix, AZ)
- …Arizona** **Position Purpose:** Lead medical record audits, monitor and analyze clinical documentation, and modify business processes to measure member outcomes. ... Assess provider performance and quality of care through clinical case reviews. + Lead clinical audits for provider medical records both remotely via electronic… more
- Centene Corporation (Charlotte, NC)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... performance oversight meetings with impacted business owners and vendors + Utilize clinical knowledge to determine audit findings and in answering counterclaims +… more
- US Tech Solutions (South San Francisco, CA)
- …+ Master's degree required. + Certified Diabetes Educator (CDCES) or equivalent mid-level clinical credential (eg, RN ). + Experience in individual education and ... and behavior change. + Direct experience developing and delivering clinical training programs. + Experience with accreditation processes. +...+ BS/BA degree in a life science, health science, RN , or related field. **About US Tech Solutions:** US… more
- University of Pennsylvania (Philadelphia, PA)
- …or related field preferred. Minimum of seven years of experience as a clinical research monitor/ auditor , research nurse or research coordinator with ... Department of Operations, Compliance and Monitoring (DOCM) is seeking a clinical research monitor/ auditor to support our clinical research mission. The… more
- Northwell Health (Garden City, NY)
- …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 ... **Req Number** 125752 Job Description Seeking RN - BSN or MSN candidates with a...- Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist- Clinical . Conducts Home Health Resource Group (HHRG) Validation to… more
- Dignity Health (Rancho Cordova, CA)
- …+ Manages and directs Revenue Integrity staff to include; Revenue Integrity Manager, Clinical Auditor ( RN ) and Revenue Integrity Analysts and Charge ... Capture Analysts + Provides analysis, communicates and reports revenue cycle performance indicators/metrics including but not limited to Artiva assist requests, edits, missed/late charge capture, avoidable adjustment and denials + Monitors departmental usage… more
- Northwell Health (Lake Success, NY)
- …of education and related experience. + Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications ... by the documentation in the Medical Record. Job Responsibility + Leverages clinical expertise to identify and validate DRG code assignment + Full review… more
- Universal Health Services (Jacksonville, FL)
- …data, interface with department heads/leadership and maintain a flexible schedule. Qualifications Registered Nurse and/or Master's Degree in Social Work, Mental ... a whole. We are pleased to announce the following available position: PRN Auditor The Temporary LCD/HBIPS Auditor is responsible for monitoring patient records… more
- HCA Healthcare (Nashville, TN)
- …where diversity and inclusion thrive? Submit your application for our Inpatient Coding Auditor opening with Parallon today and find out what it truly means to ... Eligibility for benefits may vary by location._** We are seeking a Inpatient Coding Auditor for our team to ensure that we continue to provide all patients with… more
- HCA Healthcare (Nashville, TN)
- …where diversity and inclusion thrive? Submit your application for our Inpatient Coding Auditor opening with Parallon today and find out what it truly means to ... Eligibility for benefits may vary by location._** **We are seeking a Inpatient Coding Auditor for our team to ensure that we continue to provide all patients with… more
- Omaha Children's Hospital (Omaha, NE)
- …and multiple systems to retrieve data needed for audit. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State ... concurrent reviews of all selected discharges by reconciling billing statements to clinical records and making appropriate charges and adjustments to billings based… more
- Fresenius Medical Center (Irwindale, CA)
- …related field preferred or an equivalent combination of education and experience + Registered Nurse required + Certification in Nephrology Nursing or quality ... and performance improvement activities which positively influence the assigned dialysis clinics clinical quality outcomes. The scope of the clinical quality… more
- InnovaCare (San Juan, PR)
- …MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the inpatient utilization of healthcare ... compliance with the Plan's SNP policies and MOC requirements. Clinical staff who do not complete the required annual...* Bachelor's Degree in Science of Nursing. * Current RN permanent license in Puerto Rico and Collegiate. *… more
- Covenant Health (Hobbs, NM)
- …Degree - Nursing + New Mexico Registered Nurse License + Care Manager RN Auditor , Care Manager Clinical Audit and Denial, Care Manager RN ... best people, we must empower them.** **Providence is calling a Care Manager RN , Case Management who will:** + Comprehensively plan for case management services for… more