- The Christ Hospital (Cincinnati, OH)
- …to maximize reimbursement. Maintain knowledge of current HMO/PPO/Medicaid/ Medicare /commercial insurance regulations and requirements. Requires working knowledge ... Carriers and Plan Administrators to verify patient benefits. Evaluates and prepares chart documentation to establish that Medical Necessity guidelines have been met.… more
- APLA Health (Los Angeles, CA)
- …productivity. Oversee staffing including attendance, tardiness and time off requests and review accuracy and ensure that all direct reports are recording time worked ... accurately in the PayCom system. Perform weekly medical chart audits (per the chart audit tool)...billing errors that result from registration and eligibility activities. Review encounter reports quarterly to ensure demographics are captured… more
- DHR Health (Edinburg, TX)
- …and review processes highly desirable. Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to utilization review ... time. Proceeds to issue Hospital Issued Notice of Non-coverage and Hospital Requested Review for Medicare patients according to policy. Refers cases not meeting… more
- Vanguard Medical Group (Verona, NJ)
- …minor procedures. Visit Optimization & Clinical Readiness Complete thorough pre-visit chart prep, including care gap checks, outstanding labs/imaging, and medication ... review . Anticipate provider needs and prepare accordingly to minimize...Programs Accurately capture and document quality metrics (eg, HEDIS, Medicare Annual Wellness) and screenings in the EMR. Participate… more
- Kaiser Permanente (Decatur, GA)
- …appropriate. The activities will include daily review of hospital care by chart review and discussion with attending physician, admission and concurrent ... care for hospitalized members by carrying out daily utilization and quality review , monitoring for inefficiencies and opportunities to improve care, developing a… more
- Avamere Health Services (Seattle, WA)
- …of patient care is maintained Prepare and administer medications and review medication cards for completeness and accuracy Plan, organize, develop, implement, ... staff is providing direct care in accordance with resident's care plan and wishes Chart nurses' notes in an informative and descriptive manner that reflects the care… more
- FC Compassus LLC (Lorain, OH)
- …an integrated review within 24 hours of admission. Performs a chart review daily for concurrent utilization and discharge planning. Understands payer ... corrective approaches to improve care or prevent delays. Is knowledgeable of Medicare compliance standards and assures that these standards are met. Utilizes the… more
- Eventus WholeHealth (Charlotte, NC)
- …specialty notes, hospital and SNF records are available in EHR for provider review Review patients' medical history and information from all available ... family input and specialty referrals Document client services in patients chart , including updated history and medication reconciliation from their transition of… more
- Oakwood Village (Madison, WI)
- …or issues, to ensure outcomes within recommended quality measures. Completes a comprehensive chart review of all patients readmitted or transferred to ER and ... of Federal regulations, preferred. Knowledge of the RAI process and Medicare requirements, preferred. Works in a partnership environment, which fosters effective… more
- The Centers for Advanced Orthopaedics (Bethesda, MD)
- …to achieve maximum benefit. Document treatments, responses, progress, and outcomes in the chart of the patient according to federal and state regulations and CAO ... knowledge of CPT & ICD-10 coding procedures. Thorough knowledge of Medicare and third-party billing. Thorough knowledge of Workers Compensation insurance and… more
- Elara Caring (Independence, MO)
- …written and faxed orders, and enters into appropriate system for CTM review and approval. Reviews, updates, and maintains the At-Risk registry. Provides clerical ... managers, obtaining pre-authorizations, and addressing patient questions or concerns. Performs chart audits as required by Elara Caring policy. Verifies receipt of… more
- Bassett Healthcare Network (West Winfield, NY)
- …aware of the patients' lobby experience, and completion of all referral duties. Performs chart review in preparation for providers clinic. Makes best effort to ... of Advanced Beneficiary Notice signatures and form processing to meet Medicare regulations. Ensures all corrections (demographics, insurance eligibility etc. based… more
- LHC Group, Inc. (Reno, NV)
- …all regulations, laws, policies, and procedures applicable to hospice and Medicare / Medicaid issues when applicable daily. Immediately available (or has Alternate ... daily reports on patients from staff. This process also includes review of patient care paperwork, referral information, recertification processes, discharge… more
- Opportunity Home San Antonio (San Antonio, TX)
- …to learn cloud technologies such as LucidChart for diagram, workflow and chart drawing. Experience with Vizio or equivalent is acceptable. Basic understanding of ... Identity Theft; Consumer Protection; Real Estate Matters; Document Preparation and Review , plus various other services. RETIREMENT PLANS OPPORTUNITY HOME PENSION… more
- City of Walnut Creek, CA (Walnut Creek, CA)
- …Department of Justice and FBI fingerprinting, DMV driving history review , credit check, previous/current employment references, and personal references), ... Savings (RHS) plan with a generous City contribution (see chart below) and a mandatory employee contribution of 1%...Compensation plan available . The City participates in the Medicare Program but does not participate in Social Security… more
- Winnebago Comprehensive Healthcare System (Winnebago, NE)
- …in ongoing quality assurance and performance improvement activities including audits, chart reviews, and development of review criteria. Participate in ... pharmacy services. Guidelines: Guidelines available include: AAAHC, Conditions on Medicare -Medicaid Participation, Hospital Pharmacy Policy and Procedure manual, and… more
- CVCH (Chelan, WA)
- …may be used to substituted for BLS. All Providers must be eligible for enrollment in Medicare and must not be currently opted out of the Medicare program 3. ... and governmental regulations. Ability to write reports and concise, accurate patient chart notes. Ability to effectively present information and respond to questions… more
- State of Indiana (Evansville, IN)
- …for Medicare & Medicaid Services certification as a Psychiatric Medicare /Medicaid Hospital. Role Overview: The Utilization Review Coordinator performs duties ... Utilization Review Coordinator-LPN Date Posted: Jul 18, 2025 Requisition...the chair for the Utilization Committee. This position completes chart reviews for new admissions, completes 30 day reviews,… more
- HCA Healthcare (Brentwood, TN)
- …to join an organization that invests in you as a Pro Fee Coding Quality Review Educator? At Parallon, you come first. HCA Healthcare has committed up to $300 million ... are looking for a dedicated Pro Fee Coding Quality Review Educator like you to be a part of...of unique coding requirements for major payers such as Medicare , Medicaid, HMO's, PPO's, IPA's, employers, etc. + Demonstrate… more
- HonorHealth (AZ)
- …it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of health care services ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
