- Humana (Springfield, IL)
- …a part of our caring community and help us put health first** The Compliance Nurse Auditor reviews utilization management activities and documentation to ... prevent and detect fraud, waste, and abuse. The RN Compliance Nurse 2, Quality Assurance Audit ensures...past 3 years + Experience as a Utilization Management Auditor + Health Plan experience working with large carriers… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Nurse Auditor position is responsible auditing and reconciling patient charts (ie medical record) on a daily basis or upon request from ... to accurately support reasons for treatment, billing, payment or operations. The Nurse Auditor position ensures clinical documentation supports all patient… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and compliance functions necessary to effect accurate and complete ... timely manner. + Prepares trend and other reports for compliance audits and charge processes. + Serves as a...CERTIFICATIONS + Current Virginia state license as a Registered Nurse or Registered Nurse holding a valid… more
- Molina Healthcare (Reno, NV)
- …Time Zone hours** **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case ... (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
- Northwell Health (Westbury, 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
- UPMC (Pittsburgh, PA)
- **UPMC Corporate Finance is hiring a full-time Compliance Auditor , Intermediate. This position will be based out of Forbes Tower in Pittsburgh, PA. This position ... claims processing, data collection, and quality reporting. + Conduct audits on other compliance related topics as determined to evaluate compliance with the… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- Summary With direction from the Patient Financial Services Director, the Nurse Auditor / Revenue Integrity/ CDM Analyst is responsible for performing audits of ... and advising the billing staff of appropriate HCPCS codes and modifiers. The Nurse Auditor / Revenue Integrity/ CDM Analyst works directly with revenue producing… more
- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview Our Hospice Compliance Auditors are responsible for supporting the Regional Compliance Directors with chart ... Program (EAP) + Vendor discounts Responsibilities + Works closely with Regional Compliance Directors to ensure activities of the Compliance Workplan are… more
- Molina Healthcare (Columbus, OH)
- For this position we are seeking a (RN) Registered Nurse who lives in OHIO or KENTUCY and must be licensed for the state they reside Clinical Auditor RN will ... 5 PM EST **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management… 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
- 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
- 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
- Houston Methodist (Houston, TX)
- …programs; works across the system to assess, measure, and report compliance with standards; and develops, implements and evaluates strategies to promote ... of evidence-based best practices and standardization to enhance system-wide compliance . **PEOPLE ESSENTIAL FUNCTIONS** + Collaborates and effectively communicates… more
- AdventHealth (Orlando, FL)
- …accurate reporting of enrollment and clinical trial performance, and billing compliance . * Reviews, interprets, and translates study documents such as protocols, ... accurately and timely provide builds that support the clinical, financial and compliance operations teams. * Contributes to quality control and assurance functions… more
- Ochsner Health (New Orleans, LA)
- …providers , on- site case management team, as well as LPN/RN or Nurse Auditor in the Pre-Service department. + Performs Pre-Service collection estimation ... apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards. This...and standards. This employer maintains and complies with its Compliance & Privacy Program and Standards of Conduct, including… more
- GE Vernova (Greenville, SC)
- …- Rigorously execute the supplier evaluation process, including quality & compliance audits / assessments to ensure that only appropriately qualified suppliers ... requirements + Provide technical guidance to suppliers to assure compliance with engineering drawings and specifications + Work closely...as from ASTM, ASME, EN etc + ISO Lead auditor certified by 3rd party registrar or accepted internal… more
- GE Vernova (Greenville, SC)
- …and qualification phase to final inspections in order to verify product compliance with technical and quality requirements. Supplier Quality Engineer will be working ... process audits, special process audits and product inspections to verify compliance to GE specifications & technical regulations/standards with timely audit report… more
- GE Vernova (Schenectady, NY)
- …- Rigorously execute the supplier evaluation process, including quality & compliance audits / assessments to ensure that only appropriately qualified suppliers ... + Provide technical guidance to suppliers to assure product/process compliance with engineering drawings and specifications + Work closely...such as from ASTM, ASME etc + ISO Lead auditor certified by 3rd party registrar or accepted internal… more
- CVS Health (Columbus, OH)
- …CPC's, working closely with internal and external stakeholders and ensuring compliance with regulatory requirements. The Manager develops strategies to manage ... to maintain their CEUs. Assist in preparing documentation for audits, compliance reviews, and regulatory inquiries. **Required Qualifications:** Minimum 5+ years of… more
- HCA Healthcare (San Antonio, TX)
- …true discrepancy and complete incident reports as required. You will review RX Auditor report and generate investigation reports for nurse managers/directors to ... hospital personnel politely and appropriately. You will perform and monitor compliance for quality control and performance improvement functions as assigned. You… more
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