- Medical Mutual of Ohio (OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Medical Mutual' s ... Data and Information Set (HEDIS) while adhering to HIPAA guidelines. . Supports chart retrieval activities for projects related to RAPS and HEDIS efforts. Works… more
- Behavioral Center of Michigan (Warren, MI)
- …data and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart and records clinical information ... Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …include: + Using approved criteria, conduct admission and concurrent chart reviews for Medicare /Medicaid/and managed care payers within ... Summary The Utilization Review Nurse combines clinical expertise with knowledge of...consultant to the multidisciplinary patient care team. The Utilization Review Nurse is responsible for review of… more
- HonorHealth (Scottsdale, AZ)
- …Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of health care services ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Sharp HealthCare (San Diego, CA)
- …coverage through MCA for SRS/SCMG and MPV (or Portal) for potential Medicare or Medi-Cal.Use Coordination of Benefits (COB) standards to prioritize billing order ... of insurance plans. Medicare patients - Medicare Secondary Payer (MSP)...medical records and facilitate transfers from/to outside facilities.Create patient chart for physician and organize charts for the HIM… more
- Medical Mutual of Ohio (OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Medical Mutual' s ... of risk adjustment coding for ACA (Affordable Care Act) and MA ( Medicare Advantage) with assigning and maintaining diagnoses medical codes. Evaluates requests for… more
- Atlantic Health System (Summit, NJ)
- …ICD-10 codes. Determines Coordination of Benefits (COB) for multiple insurances. Completes Medicare questionnaire for all Medicare patients. Follows established ... needed. Dismantles charts and assures all documentation/forms are on chart . Completes appropriate chart completion form and...100 Accountable Care Organizations to Know - Becker's Hospital Review + Best Employers for Workers over 50 -… more
- Corewell Health (Stevensville, MI)
- …of last day of Medicare A coverage. + Performs audits and quality review duties as assigned by Manager. Monitors accuracy of MDS items completed by other ... Ridge is a 111-bed Skilled Nursing Facility that is Medicare and Medicaid Certified with 33 private rooms and... and Medicaid requirements. Essential Functions + Reviews nursing chart on resident information and performs evaluations as needed… more
- Mount Sinai Health System (New York, NY)
- …registered; Completes the central log assuring all fields are complete + Completes Medicare Payor Questionnaire for all Medicare patients + Collects visit fees ... Patient Registration log + Makes appropriate copies of complete chart and stores in dedicated locations + Disburses ... + Gives attending physician walk out charts for review twice daily **About Us** **Strength Through Diversity** The… more
- St. Luke's University Health Network (Reading, PA)
- …education of network policy on Patient Identification including Mark for Merge, Chart Corrections, and Patient Look-Up. + Responsible for the patient registration ... related to registration. Can require contacting provider office, reviewing patient medical chart for diagnosis and medical necessity information. + Required to cross… more
- Tufts Medicine (Burlington, MA)
- …is reported. Partner with practices to review findings of the periodic chart review . 4. Maintains a thorough understanding of anatomy and physiology, medical ... of ICD-10-CM diagnosis codes. The coder will focus on chart reviews, the detailed physician chart abstraction,...compliance with internal and government regulations. 3. Provides continuing review and education of physician and ACPs to ensure… more
- Sutter Health (Sacramento, CA)
- …team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted ... agreed upon) with a signed Sutter Skilled Nursing Facility, Medicare Advantage, and Medicare Shared Savings Program...and other large volume providers. JOCs to include: + Review of utilization performance by product MA, MSSP &… more
- Fresenius Medical Center (Westerville, OH)
- …(supply inventory for order, Kt/V collection, bringing meds to clinic visit for review ) + Prepare initial patient chart for admission. Complies and maintains ... the designated clinical application in an accurate and timely manner. + Review treatment sheets for completeness, ensure nursing signatures are documented, and… more
- Fresenius Medical Center (Philadelphia, PA)
- …(supply inventory for order, Kt/V collection, bringing meds to clinic visit for review ) + Prepare initial patient chart for admission. Complies and maintains ... the designated clinical application in an accurate and timely manner. + Review treatment sheets for completeness, ensure nursing signatures are documented, and… more
- CenterWell (Durham, NC)
- …has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality primary ... for patients and monitors care using available data and chart reviews. + Assists in the coordination of patient...byClinical Leadership. + Meets with RMD about quality of care, review of outcome data,policy, procedure and records issues. +… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …Director of Patient Accounts regarding assigned HCPC codes and modifiers + Receive, review , verify, and process requests for chart audits of inpatient ... random quality audits as schedule permits + Work and review a high volume of accounts assigned to Revenue...procedures by following the ICD-10-CM, Uniform Hospital Data Set, Medicare , Medicaid, and other fiscal intermediary guidelines + Report… more
- TEKsystems (Chesapeake, VA)
- …the Director of Patient Accounts regarding assigned HCPC codes and modifiers Receive, review , verify, and process requests for chart audits of inpatient ... in a timely manner. Perform random quality audits as schedule permits Work and review a high volume of accounts assigned to Revenue Integrity Nurse Auditor work… more
- Hackensack Meridian Health (Neptune, NJ)
- …admissions and observations as specified by the facility's Utilization Management/ Review Committee for documentation completeness and compliance with patient status. ... with the physician have been documented in the patient's chart . + As appropriate, documents and analyzes data and...Participates in concurrent performance improvement activities and on-going MR review activities. + Reviews 3M 360 tracking data in… more
- Hackensack Meridian Health (Hackensack, NJ)
- …admissions and observations as specified by the facility's Utilization Management/ Review Committee for documentation completeness and compliance with patient status. ... issues discussed and clarified with the physician have been documented in patient's chart . + As appropriate, documents and analyzes data and reports instances of… more
- Option Care Health (Dublin, OH)
- …is maintained by providing direct patient care 20-40% of the time. In a Medicare Certified Home Health agency, this position may also serve as the alternate ... + Acts as Administrator and/or Director of Nursing of the Home Health Agency for Medicare certified home health agencies in the absence of a director or Manager of… more