- 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
- 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
- PeaceHealth (Vancouver, WA)
- …experience/training (eg, RN ) preferred. + Certified Public Accountant, Certified Internal Auditor or Certified Information Systems Auditor + Registered ... Health Information Administrator (for Coding Auditor ), Registered Health Information Technician (for Coding Auditor ), Certified Professional Coder (for… more
- Centene Corporation (Sacramento, CA)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... to CMS, NCQA, Federal and State requirements. + Lead compliance audits of vendors. Identify audit scope and required...Train internal audit participants/business owners on audit tools and Medical Management criteria including CM, DM, and UM +… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …programs + And more **Description** We are seeking a **Lead CDI DRG Auditor ** responsible for identifying areas of documentation improvement such as DRG accuracy, ... compliance , severity of illness, risk of mortality and risk...risk of mortality and risk adjustment factors during inpatient medical record review. This individual: + Conduct audits retrospective… more
- Molina Healthcare (CA)
- …during our interview process._** **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization ... this position we are seeking a (LVN / LPN) Nurse with previous experience in Case management, Acute Care,...Disease Management (DM) and 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
- Molina Healthcare (Phoenix, AZ)
- …QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist, Quality Improvement ( Registered Nurse ) contributes to one or more of these ... **Molina Healthcare** is hiring several **Quality Improvement, Auditor RN 's** and/or **LPN'** s in...Certified Professional in Health Quality (CPHQ) + Certified HEDIS Compliance Auditor (CHCA) + Registered … 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
- 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
- Henry Ford Health System (Troy, MI)
- …report of findings, and shares with departmental leadership. 6. Coordinates with RI Auditor to review accounts comparing the medical record and itemized bill ... document workflows. Primary areas of focus include increased revenue capture, compliance , and decreased denials. PRINCIPLE DUTIES AND RESPONSIBILITIES: 1. Actively… 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
- HCA Healthcare (Nashville, TN)
- …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and… more
- HCA Healthcare (Austin, TX)
- …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and… more
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