- Elevance Health (Miami, FL)
- **Provider Auditor ** _This position will work a hybrid model ( remote and office), 1 time per week. The Ideal candidate will live within 50 miles of one of our ... to recover, eliminate and prevent unnecessary medical-expense spending. The **Provider Auditor ** conducts on-site reviews of medical charts, medical notes, itemized… more
- Fairview Health Services (St. Paul, MN)
- …for multiple specialties, including laboratory and behavioral health services. The Senior Auditor will: + Lead advanced, complex compliance audits and ... **Job Overview** **Fairview is looking for a Senior Corporate Compliance Auditor to join our Corporate Compliance department.** **Bring Your Possibilities to… more
- Ochsner Health (New Orleans, LA)
- …management. Performs and documents audits and presents oral and written conclusions to the Lead Nurse Auditor and department management. Educates and assists ... Required - Certification as CPC, CCS, CHC, RHIA, RHIT, RN , or LPN or other related certification. **Knowledge Skills...through auditing and monitoring or other means to the Lead Nurse Auditor and/or designated… more
- Centene Corporation (New York, NY)
- …flexibility. **Must reside in New York with a New York state LPN or RN licensure.** **Position Purpose:** Lead medical record audits, monitor and analyze ... provider performance and quality of care through clinical case reviews. + Lead clinical audits for provider medical records both remotely via electronic medical… more
- Centene Corporation (Columbia, SC)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Lead , monitor and evaluate the performance of national delegated vendors ... managed care practices and policies preferred. **Licensure/Certifications:** Current state RN license required. Valid driver's license. Pay Range: $68,700.00 -… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... NYS DOH, CMS, NCQA, and HEDIS, serving as internal auditor within the group. + Responsible for all aspects...Associates degree required. Bachelor's degree preferred. + Active NYS RN or Registered Dietician or Physical Therapist… more
- Molina Healthcare (OH)
- …to improve care and service. + Serves as operations and implementation lead for Molina Plan quality improvement interventions using a defined roadmap, timeline, ... to national, regional and plan meetings. + Demonstrates ability to lead and influence cross-functional teams that oversee implementation of quality interventions.… more
- Molina Healthcare (Tucson, AZ)
- …continuous improvement of intervention processes and outcomes. Acts as a lead specialist within the department and/or collaboratively with other departments. **Job ... Duties** + Acts as a lead specialist to provide project, program, and/or initiative related...Certified Professional in Health Quality (CPHQ) + Nursing License ( RN may be preferred for specific roles) + Certified… more