- Banner Health (AZ)
- …this leading-edge work, we invite you to bring your experience and skills to BPN. As a Registered Nurse Auditor , you will serve as a vital part of the Banner ... leadership team. Provides compliance /documentation education sessions to Medical Directors of Care Coordination (MDCC) RN ...of a bachelor's degree in nursing or related field. Registered Nurse ( RN ) licensure in… 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...assignment can be substantiated by the documentation in the Medical Record. Job Responsibility + Audits and reviews Medicare/non-Medicare… more
- Northwell Health (Garden City, NY)
- …combination of education and related experience. 2.Current License to practice as a Registered Professional Nurse in New York State required, plus specialized ... **Req Number** 137052 Job Description **Seeking RN - BSN or MSN candidates with a...assignment can be substantiated by the documentation in the Medical Record. Job Responsibility 1.Leverages clinical expertise to identify… more
- LA Care Health Plan (Los Angeles, CA)
- …Computer ease & literacy with Word, Excel, PowerPoint Skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Delegation Oversight Clinical Auditor RN II Job Category: Clinical...Monitoring): In addition to the responsibilities above, the Clinical Auditor (Performance Monitoring) position ensures compliance of… more
- Houston Methodist (Cypress, TX)
- …auditing in a surgical or hospital setting **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure and/or Compact ... At Houston Methodist, the Nurse Auditor position is responsible auditing...State Licensure within 60 days **OR** + RN -Temp - Registered Nurse -… more
- 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 containment. Join our team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and… more
- Molina Healthcare (Dallas, TX)
- …to resolve/correct them. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and Associate's or ... **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions...Disease Management (DM). + Monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May… more
- InnovaCare (San Juan, PR)
- …electronically application in accordance with NCQA and CMS regulations to assure compliance standards and federal regulations utilizing established medical care ... MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the inpatient utilization of healthcare… more
- Brockton Hospital (Brockton, MA)
- …focus on government payers, including Medicare and Medicaid. Collaborate with SHC's Healthcare's Compliance Auditor to meet audit plan objectives. + Works with ... Working knowledge of Electronic Medical Records, Excel, Word and PowerPoint. + Other: Experience with Wolters Kluwer or Symplr Compliance platform a plus. more
- Providence (OR)
- …software/tools **Preferred qualifications for this position include:** + Clinical background such as Registered Nurse ( RN ), Doctorate of Medicine (MD), or ... action completion and behavior change + Provide education related to coding, medical record documentation requirements, healthcare compliance and fraud, waste… more
- MyFlorida (Tallahassee, FL)
- …to key performance indicators. Reports findings to management. Must be licensed as a Registered Nurse in the state of Florida. Florida Statutes Reference: 464, ... the Specialty Programs Unit Director. This individual is a medical subject matter expert that performs independent and complex...Health Nursing Experience + Must be licensed as a Registered Nurse in the state of Florida.… 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
- University of Virginia (Charlottesville, VA)
- …Specialist (CCDS) Certified Documentation Improvement Specialist (CDIS) Certified Professional Medical Auditor (CPMA) or Certified Coding Specialist CCS ... serves as a resource for the CDI team. Oversees compliance with Centers for Medicare & Medicaid Services' (CMS)...Preferred. Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia… more
- R1 RCM (Chicago, IL)
- …and external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + **Active AHIMA or AAPC Coding Certification** including ... Nurse ** , you will help review and interpret medical records to draft appeals of denied and underpaid...a Clinical Validation Review by an insurer or third-party auditor . + Draft appeal letters that are well-written, logically… more
- Commonwealth Care Alliance (Boston, MA)
- …Professional Coder (CPC) + Certified Inpatient Coder (CIC) + Certified Professional Medical Auditor (CPMA) **Desired Education (nice to have):** + Masters ... direction of the Sr. Director, TPA Management and Claims Compliance , Healthcare Medical Claims Coding Sr. Analyst...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- CommonSpirit Health Mountain Region (Colorado Springs, CO)
- …setting. + RN experience highly preferred; although technical skills and medical experience may substitute. + Colorado RN license, preferred Physical ... and leaders who care about your success. The clinical auditor performs clinical and operational audits as a means...as a means of verifying accuracy of information and compliance to established policies, practices, and regulations. Responsible for… more
- Commonwealth Care Alliance (Boston, MA)
- …Role is Important to Us:** **Position Summary:** Reporting to the Chief Risk, Compliance & Ethics Officer, the Vice President, Chief Privacy & Security Officer ... oversight, auditing, monitoring, and ongoing operation of CCA's privacy and security compliance assuring that it meets all requirements of applicable federal and… more