- Providence (WA)
- …for conducting clinical quality audits for the Quality Department. The auditor identifies and coordinates clinical audits to determine potential areas for ... regarding charts require auditing will be provided by staff Clinical QI Coordinator RNs. The auditor maintains...**Required Qualifications:** + Degree in Nursing + Oregon Registered Nurse License + 5+ years clinical experience… more
- 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 ... services rendered is complete, compliant and accurate to support optimal reimbursement. The Nurse Auditor 2 work assignments are varied and frequently require… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and compliance functions necessary to effect accurate and complete ... focus audits and reports findings. + Serves as a clinical resource for coding / denial management and customer...CERTIFICATIONS + Current Virginia state license as a Registered Nurse or Registered Nurse holding a valid… more
- Elevance Health (Las Vegas, NV)
- **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This role enables associates to work virtually ... an accommodation is granted as required by law. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records… more
- UNC Health Care (Chapel Hill, NC)
- …from entity to entity across the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides elbow to elbow support during ... we serve. Summary: This positon trains and audits Inpatient and Outpatient Clinical Documentation Specialists (CDS) across all HCS entities that are owned or… more
- Trinity Health (Livonia, MI)
- …Actions & Promise in behaviors, practices & decisions. **Work Focus:** Performs clinical care activities (direct or indirect) for patients within the "scope of ... laws & training received; Cares for patients safely by assisting in clinical care services or engaging in administrative activities (eg, maintaining records or… more
- Northwell Health (Westbury, NY)
- …a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist- Clinical . Conducts Home Health Resource Group (HHRG) Validation to ensure the ... + Instructs professional staff in code changes, as needed. + Assists clinical staff and nursing supervisors in providing appropriate documentation in the Medical… more
- Northwell Health (Garden City, NY)
- …HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist- Clinical . Hybrid or Remote Job Responsibility 1.Leverages clinical ... and related experience. 2.Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed.… more
- AdventHealth (Orlando, FL)
- …Full Time **Shift** : Days **Location: Remote** **The role you'll contribute:** The Clinical Documentation Integrity Manager is a Registered Nurse and/or a ... Registered Health Information Administrator with a high level of clinical proficiency necessary for the oversight of the Clinical Documentation team which is… more
- Henry Ford Health System (Detroit, MI)
- …in EPIC. Proposes corrective action in charge capture problem areas. Reviews clinical documentation to ensure all records match. Participates in clinical ... Two (2) years of Cath lab experience to gain clinical knowledge and analytical abilities to make informed decisions...Interventional (VI) or license to practice as a registered nurse in the state of Michigan. * BLS/ACLS. Additional… more
- Insight Global (South Jordan, UT)
- …criteria, and coding terminology. Expert coding knowledge (DRG & ICD-10) Registered Nurse RN (must be inpatient) WITH coding/ clinical documentation certification ... Job Description Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100%...in clinical documentation) OR IF NOT A NURSE : Degree in RHIM, RHIA, RHIT with medical coding… more
- AdventHealth (Orlando, FL)
- …The Surgical and Procedural Services Safety and Regulatory Compliance Auditor evaluates the surgical and procedural environment, policies, and procedures ... and regulations. Responsible for performing routine readiness rounding in clinical areas to identify areas of opportunity and prepare...Florida or multi state license as a Licensed Practical Nurse **or** + RN current valid State of Florida… more
- CVS Health (Phoenix, AZ)
- …heart, each and every day. **Position Summary** The **Healthcare Quality Management Auditor ** participates in the development and ongoing implementation of QM ( ... to)** + Completes a variety of onsite medical and clinical audits for all lines of business, including AHCCCS...in QM meetings. **Required Qualifications** + Active RN (Registered Nurse ) or LPN (Licensed Practical Nurse ) license,… more
- US Tech Solutions (Newark, NJ)
- …months contract with potential extends or Convert** **Job Description:** + The HEDIS Nurse Auditor is responsible for conducting quality audits related to state ... to identify trends and facilitate quality improvement initiatives. + Assist with clinical studies, quality projects, and audits. + Lead and coordinate Corrective… more
- Molina Healthcare (Syracuse, NY)
- JOB DESCRIPTION Job SummaryProvides support for healthcare services clinical auditing activities. Performs audits for clinical functional areas in alignment with ... in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with… more
- Centene Corporation (Jefferson City, MO)
- …the auditing of corporate, health plan, and specialty company staff related to clinical systems entry and/or processes + Develop and maintain the audit process and ... audit errors + Coordinate auditing outcomes and system maintenance with the Sr. + Clinical Systems Specialist to resolve or enhance clinical systems + Performs… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …drivers. Essential Accountabilities: Level I + Handles physical health member clinical management programs. + Maintains knowledge of current Case Management Society ... or external referral sources. Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management… more
- St. Luke's University Health Network (Allentown, PA)
- …or coding determination made by the government or commercial payors, or their auditor representative. + Facilitate clinical chart reviews to assist with ... regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and… more
- University of Southern California (Los Angeles, CA)
- As the center of clinical charge capture, the Revenue Integrity (RI) Specialist provides leadership to the daily CDM maintenance workflow between the various ... coordinates with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge… more
- CommonSpirit Health (Colorado Springs, CO)
- …with resources to help you flourish and leaders who care about your success. The clinical auditor performs clinical and operational audits as a means of ... High School Diploma or GED required + Associate's Degree required + Registered Nurse Preferred State of employment RN license, preferred **Where You'll Work** We… more