- Rising Medical Solutions (Chicago, IL)
- …business was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost ... team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance… more
- Northwell Health (Garden City, NY)
- …Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations. 5.Applies coding rules and regulations ... the validation review process. 6.Reviews codes on Medicare/non-Medicare charts for compliance to rules and conventions. 7.Communicates DRG changes and rationale to… more
- Northwell Health (Garden City, 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
- LA Care Health Plan (Los Angeles, CA)
- … (Performance Monitoring): In addition to the responsibilities above, the Clinical Auditor (Performance Monitoring) position ensures compliance of the delegates ... to management as well as consultation/coaching/instructional activities to improve overall compliance with all regulations and standards. Clinical Auditor … more
- Option Care Health (Phoenix, AZ)
- …Reporting to the Director, Clinical Services Nursing, the Nursing Quality Assurance Auditor supports OCH's Clinical and Quality standards through on location and ... remote reviews to monitor performance. The Nursing Quality Assurance Auditor is responsible for the on-going facilitation and completion of the Quality Assessment… more
- Somatus (Mclean, VA)
- …and mental well-being + Community engagement opportunities + And more! The Quality Auditor effectively and efficiently manages a diverse workload in a fast- paced, ... rapidly growing environment. The Quality Auditor provides support to the local market teams but reports centrally to the Director of Audit and Risk. This individual… more
- SSM Health (St. Louis, MO)
- …MO-SSM Health Mission Hill **Worker Type:** Regular **Job Highlights:** RN-Clinical Auditor Manager, Care Transformation - Case Management and Social Work 7 ... Review, and Case Management departments. Performs operational audits and compliance audits adhering to regulatory requirements. Standardizes policies, procedures and… 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
- R1 RCM (Chicago, IL)
- …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
- 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
- Providence (CA)
- …such as Accredited Healthcare Fraud Investigator (AHFI), Certification as an Internal Auditor (CIA), Healthcare Compliance certification (CHC), or equivalent + ... Special Investigation Unit who will:** + Support timely completion of compliance related audits and investigations of the Special Investigations Unit (SIU)… more
- Highmark Health (Pittsburgh, PA)
- …Information Systems Auditor (CISA + Juris Doctorate (JD) + Registered Nurse (RN) + PharmD **SKILLS** + Demonstrate expert knowledge of business and technology ... in Increasing accountability and/or progressive role, preferably in an audit or compliance discipline in a healthcare or healthcare related industry **Preferred** +… more
- Covenant Health Inc. (Knoxville, TN)
- …Covenant Health standards of Telephone Excellence policy. + Refers patient accounts to nurse auditor upon request by patient or insurance company, and monitors ... guidelines and other Third Party Payor requirements assuring departmental compliance . + Recognizes situations, which necessitate supervision and guidance, seeks… more
- MD Anderson Cancer Center (Houston, TX)
- …in order to prepare for Progress Reports * Continuous monitoring of compliance status of your manuscripts in My NCBI **Protocol Regulatory Coordination:** Works ... and /or government sponsors). * Provides direct support to research nurse /data coordinator for research protocols. * Coordinates regulatory correspondence on all… more