- PruittHealth (Norcross, GA)
- **JOB PURPOSE:** The Compliance Auditor (CA) reports directly to the Vice President of Compliance (VPC) to conduct compliance audits for Health Care ... SOURCE/CCSP service lines. The CA performs routine and focused internal compliance investigations, audits and assessments throughout the organization and develops… more
- Northwell Health (Glen Cove, NY)
- …reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. + Applies coding rules and ... the validation review process. + Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. + Instructs professional staff in code… 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 ... ICT and health assessments. Staff will notify supervisors of any processes not in compliance with the Plan's SNP policies and MOC requirements. Clinical staff who do… more
- UPMC (Pittsburgh, PA)
- **UPMC Health Plan is looking for an Intermediate Clinical Auditor /Analyst to join the Quality Assurance team!** The Intermediate Clinical Auditor /Analyst is an ... training new staff and auditing peers. Collects program data to monitor/ensure compliance requirements and establishes and revises better best practice within the… more
- UNC Health Care (Chapel Hill, NC)
- …the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides elbow to elbow support during training and education as well as ... all patients. Educates on proper creation of provider compliant queries. 8. Ensures compliance with third party and State and Federal regulations. 9. Audits CDS… more
- Magellan Health Services (Albuquerque, NM)
- …the appropriate assessments. Provides feedback to the clinical teams on contractual compliance and quality of work within the case management system. Provider ... and demonstrated experience. General Job Information Title CISC Clinical Auditor Grade 25 Work Experience - Required Clinical Work...PSY - Psychologist - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care Mgmt… more
- Molina Healthcare (Dallas, TX)
- **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), ... (HM), and/or Disease Management (DM). + Monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-clinical… more
- UCHealth (Colorado Springs, CO)
- …charges are entered for patient care services, following regulatory billing compliance guidelines. Communicates estimates of charges for services, corrects problems ... with Finance on perioperative services charges. Ensures charges follow regulatory compliance billing guidelines. + Assists in training staff to verify and… more
- Northwell Health (Lake Success, NY)
- …reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. + Applies coding rules and ... the validation review process. + Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. + Communicates DRG changes and rationale to… more
- Fresenius Medical Center (Irwindale, CA)
- …to the Clinical Quality leadership, Education, Clinical Services, Regulatory and Compliance to take the appropriate steps to facilitate achievement of quality ... or an equivalent combination of education and experience + Registered Nurse required + Certification in Nephrology Nursing or quality preferred. **EXPERIENCE… more
- Fairfax County Sheriff's Office (Fairfax, VA)
- …Health + Experience working as a Nurse Educator or Healthcare Auditor + Experience working in quality assurance/ compliance within a healthcare setting. ... Quality Assurance Nurse (Correctional Health Nurse IV) Print...supervision of staff and monitoring of contractor performance for compliance with quality assurance standards. Supports best practice approaches,… more
- R1 RCM (Salt Lake City, UT)
- …AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to draft ... you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal...a Clinical Validation Review by an insurer or third-party auditor . + Draft appeal letters that are well-written, logically… more
- UNC Health Care (Rocky Mount, NC)
- …and well-being of the unique communities we serve. **Summary:** The Recovery Audit Nurse will work closely with other Business Office staff members to assist in ... or prospective review, ie - Medicare and Medicaid RA (Recovery Auditor ) programs. **Responsibilities:** + Ensuring compliant billing guidelines + Assistance with… more
- University of Pennsylvania (Philadelphia, PA)
- …as well as assisting with corrective actions and training related to research compliance , quality control and quality assurance. The monitor/ auditor will follow ... field preferred. Minimum of seven years of experience as a clinical research monitor/ auditor , research nurse or research coordinator with at least three years'… more
- GE Aerospace (Lafayette, IN)
- …quality management issues and is responsible for site Quality System documentation and compliance to the Quality System requirements. This job is expected to be an ... and Responsibilities** + Ensure safe practices are used in compliance with all government and GE Aerospace regulations. +...Improvement methods + Knowledge of AS9100 standards + S-026 Auditor Certified or ASQ Certified Quality Auditor … more
- Immigration and Customs Enforcement (IN)
- …Health Service Corps (IHSC), Office of Deputy Assistant Director for Healthcare Compliance , Health Plan Management Unit (HPMU). This is a supervisory position. This ... for optimum utilization of personnel, facilities and equipment. Incumbent ensures compliance with program regulations (eg, appropriateness of health care and… more
- State of Indiana (IN)
- …learn, work, or play. Role Overview: This position will serve as a nurse surveyor/ auditor for birthing facilities and neonatal intensive care units (NICUs). ... will provide in-depth analysis of birth facilities to determine compliance with the Title 410, Article 39: Perinatal Hospital...state. You will need to possess an active Registered Nurse (RN) license to be eligible for this role.… more
- Medical Mutual of Ohio (OH)
- …. Reviews data sources to ensure accuracy and validity in compliance with HEDIS technical specifications, policies, and operating procedures. Identifies, researches, ... and vendor project planning coordination and facilitation. Works with IT and Clinical Nurse staff to aid in the loading of HEDIS data and collection of… more
- MTC (Post, TX)
- …supervisor. Responsible for the overall management of security functions in compliance with Management & Training Corporation (MTC) and customer directives. ... policies and procedures affecting security, coordinate withother departments to ensure compliance and overall facility objectives. + Direct procedures and practices… more
- City of Long Beach (Long Beach, CA)
- …city-wide elected Mayor. Other elected officials include the City Attorney, City Auditor , and City Prosecutor. The elected officials are elected to staggered ... the HIV Care Clinic, and communicable disease patients; + Provides supervision to Nurse Practitioner(s) and or Advanced Practice Registered Nurse (s) ; + Orders,… more