- LA Care Health Plan (Los Angeles, CA)
- Delegation Oversight Clinical Auditor RN II Job Category: Clinical Department: Executive Services Location: Los Angeles, CA, US, 90017 Position Type: ... to achieve that purpose. Job Summary The Delegation Oversight Clinical Auditor RN II is...& literacy with Word, Excel, PowerPoint Skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Healthfirst (NY)
- The Clinical Auditor performs audit functions for Healthfirst clinical teams (eg Care Management, Reassessment/ Clinical Eligibility, Utilization ... to ensure audits and reports are value-added + Applies clinical and critical thinking skills to evaluate the quality...Additional duties as assigned Minimum Qualifications: + LPN, NYS RN license. + In order to access the Uniform… more
- Elevance Health (Metairie, LA)
- …through Friday.** **TRAVEL: Travel is required to provider locations in Louisiana.** The Clinical Quality Auditor Sr. is responsible for ensuring clinical ... define and evaluate problems and propose solutions. **Required Qualifications** + Current unrestricted RN or LCSW license issued by the state of Louisiana. + Minimum… more
- Intermountain Health (Columbus, OH)
- **Job Description:** The goal of the Clinical Documentation Specialist- Auditor is to improve the accuracy of the overall clinical picture and the ... physician and coding staff. Minimum Qualifications Bachelor's degree in a clinical field (eg RN , RRT, PT, OT, SLP, LCSW). Education must be obtained through… more
- UNC Health Care (Chapel Hill, NC)
- …Association) certification - AAPC (American Academy of Professional Coders) certification - RN ( Registered Nurse ) license - LPN (Licensed Practical ... across the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides elbow to elbow support during training and education… 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)
- …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, ... performance oversight meetings with impacted business owners and vendors + Utilize clinical knowledge to determine audit findings and in answering counterclaims +… more
- Emory Healthcare/Emory University (Atlanta, GA)
- **Description** **JOB DESCRIPTION:** The Lead Clinical Documentation Integrity (CDI) DRG Auditor works under the direction of the Associate Director of CDI ... and Education. He/she performs all the requirements of the Lead CDI DRG Auditor . In addition, this position is responsible for identifying areas of documentation… 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 ... Department of Operations, Compliance and Monitoring (DOCM) is seeking a clinical research monitor/ auditor to support our clinical research mission. The… 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** 108569 Job Description Seeking RN - BSN candidates with a HCS-D -...- Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist- Clinical . Conducts Home Health Resource Group (HHRG) Validation to… 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
- 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 ... Capture Analysts + Provides analysis, communicates and reports revenue cycle performance indicators/metrics including but not limited to Artiva assist requests, edits, missed/late charge capture, avoidable adjustment and denials + Monitors departmental usage… more
- Universal Health Services (Richmond, VA)
- …Kingdom. https://uhs.com/ The Atlantic Region CBO is seeking a dynamic and talented Senior Nurse Auditor . The primary responsibility of the Senior Nurse ... supporting the team with process questions while they analyze clinical claim denials, draft detailed appeal letters, evaluate ...in creating and maintaining work flow processes to help nurse auditor team to be proficient in… 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 ... Eligibility for benefits may vary by location._** **We are seeking a Inpatient Coding Auditor for our team to ensure that we continue to provide all patients with… 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 ... _Note: Eligibility for benefits may vary by location._ We are seeking a Inpatient Coding Auditor for our team to ensure that we continue to provide all patients with… more
- RWJBarnabas Health (Oceanport, NJ)
- Physician Billing Auditor - Oceanport, NJReq #:0000137296 Category:Professional / Management Status:Full-Time Shift:Day Facility:RWJBarnabas Health Corporate ... 2 Crescent Place, Oceanport, NJ 07757 Job Overview: The Physician Billing Auditor prepares and conducts employed provider billing audits according to the current… more
- Fresenius Medical Center (Irwindale, CA)
- …related field preferred or an equivalent combination of education and experience + Registered Nurse required + Certification in Nephrology Nursing or quality ... and performance improvement activities which positively influence the assigned dialysis clinics clinical quality outcomes. The scope of the clinical 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...* Bachelor's Degree in Science of Nursing. * Current RN permanent license in Puerto Rico and Collegiate. *… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …An approved certification such as CIA, CPA, CFE, CISA, or other business or clinical licensures (eg RN ) as approved by department management is preferred. ... **ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS** + Perform detail testing for financial audits and internal audits to ensure completion of the departmental audit plan while demonstrating sound judgment and decision making, commitment to tasks, persistence in… more
- Centene Corporation (Austin, TX)
- …+ Conducts training needed analyses to determine specific training needs for clinical and coding staff + Identifies, selects, or develops appropriate training ... setting. **Required License/Certification:** CIC or CCS certification **Preferred License/Certification:** RN or LPN licensePay Range: $54,000.00 - $97,100.00 per… more