- 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 ... services . + Prepares monthly performance reports for the clinical team to support quality of work and contract...skills and demonstrated experience. General Job Information Title CISC Clinical Auditor Grade 25 Work Experience -… 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 (Charlotte, NC)
- …be 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, ... findings, and vendor performance + Develop audit tools based on contracted services with vendors and requirements defined by CMS, State, Federal, Medicaid and/or… more
- Healthfirst (PA)
- …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
- UNC Health Care (Chapel Hill, NC)
- …Association) certification - AAPC (American Academy of Professional Coders) certification - RN ( Registered Nurse ) license - LPN (Licensed Practical ... are owned or managed that have opted into shared services . This position reports to the HCS Supervisor Coding...across the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides… 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
- 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 ... of Operations, Compliance and Monitoring (DOCM) is seeking a clinical research monitor/ auditor to support our ...you cover some of the costs of long-term care services received at home, in the community or in… more
- Geisinger (Danville, PA)
- …of 5 years-Health Insurance/Managed Care (Required) Certification(s) and License(s) Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania; Basic ... status. Coordinates readmission review. Conducts Inpatient and Outpatient post service reviews and determines coverage based on medical necessity. Applies… 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 ... must empower them.** **Providence is calling a Care Manager RN , Case Management who will:** + Comprehensively plan for...Management who will:** + Comprehensively plan for case management services for a targeted patient population + Carry out… 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 ... Responsibilities Universal Health Services , Inc., one of the nation's largest and...are pleased to announce the following available position: PRN Auditor The Temporary LCD/HBIPS Auditor is responsible… 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
- 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 ... include:** + **Comprehensive medical coverage that covers many common services at no cost or for a low copay....3% to 9% of pay (based on years of service )** + **Employee Stock Purchase Plan with 10% off… 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 ... include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay....3% to 9% of pay (based on years of service ) + Employee Stock Purchase Plan with 10% off… more
- Fresenius Medical Center (Irwindale, CA)
- …+ Collaborates with appropriate stakeholders including but not limited to the Clinical Quality leadership, Education, Clinical Services , Regulatory and ... related field preferred or an equivalent combination of education and experience + Registered Nurse required + Certification in Nephrology Nursing or 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...care, on site or telephonically to validate appropriateness of services , lengths of stay and levels of care, utilizing… 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 ... to ensure accurate and timely charge capture foreach facility in the Service Area. Responsible for CDM compliance, pricing, and education/training of staff and… more
- Intrepid USA (Murray, KY)
- …Capable of making challenging decisions and willing to take responsibility for them. + Current Registered Nurse license in the state of practice + One (1) year ... home hospice, private duty homecare and independent living support services delivered in a concierge style, on-demand to create...state and governing agency regulations + Participates in continued clinical and in- service education, as well as… more
- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Clinical Review and Coding Nurse is responsible to attain procedure and diagnosis coding ... accuracy and consistency on referred cases. The RN will perform and coordinate the clinical ...evaluation of programs, and recommend areas for improvement. The RN will also research new technology or services… more
- Baystate Health (Springfield, MA)
- …Team Operations Associate Cardiac Monitor Tech will function in a supportive role to a registered nurse and work collaboratively with the health care team in the ... communication with NEOPO and related paperwork in conjunction with RN . Screen calls for clinical team and...forms, etc. **8)** Unit Resource: Post/file MD schedules for clinical team inquiry. In coordination with charge nurse… more