- SSM Health (MO)
- …Illinois Department of Financial and Professional Regulation (IDFPR) State of Work Location: Missouri + Registered Nurse ( RN ) Issued by Compact State + Or + ... compliant with regulatory requirements and standards are maintained. Performs clinical audits within Care Transformation operations by supporting the...Registered Nurse ( RN ) - Missouri Division of Professional… more
- Medical Mutual of Ohio (OH)
- … experience, DRG,_** **_and/or_** **_hospital bill auditing experience._** **Responsibilities** ** Clinical Auditor ** + **Audits outpatient, inpatient and ... recovery staff.** + **Performs other duties as assigned.** **Sr Clinical Auditor ** + **Audits outpatient, inpatient and...Auditor ** **Education and Experience** + Graduate of a registered nursing program approved by the Ohio State Nursing… more
- Elevance Health (Columbus, OH)
- …would provide an equivalent background. + Requires current, active, unrestricted Registered Nurse license in applicable state(s). **Preferred Skills, ... **Diagnosis Related Group Clinical Validation Auditor ** **Location:** This position...are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical … more
- Molina Healthcare (Dallas, TX)
- **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management ... Management (HM), and/or Disease Management (DM). + Monitors key clinical staff for compliance with NCQA, CMS, State and...them. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and… more
- Elevance Health (Metairie, LA)
- ** Clinical Quality Auditor Sr.** **Location** : The territory for this position is the State of Louisiana. The ** Clinical Quality Auditor Sr.** is ... Requires BS in nursing, health sciences, health management or a related clinical field and minimum of 5 years of experience in utilization management,… 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 ... compliance with the Plan's SNP policies and MOC requirements. Clinical staff who do not complete the required annual...to the Health Services Department / UM Medical Care Manager a monthly report of activities performed.15. Attends all… more
- University of Washington (Seattle, WA)
- …changes impacting revenue cycle **REQUIREMENTS** + Active licensure to practice as a Registered Nurse in Washington State + Bachelor's degree in Nursing + ... **UW MEDICINE'S PATIENT FINANCIAL SERVICES Department** has an outstanding opportunity for a ** CLINICAL APPEALS AND DISPUTES NURSE ** **Work Schedule** + 100% FTE… more
- Blue KC (Workman, MN)
- …**Employee discount program** **Job Description Summary:** The Quality Performance Analyst RN provides clinical interpretation of medical records for HEDIS(R) ... reporting. This position involves abstraction of clinical information from medical records that meet Hedis measure...the coordination, development and writing of the first HEDIS(R) Auditor Training Manual and program. + Subject matter expert… more
- Baystate Health (Springfield, MA)
- …Team Operations Associate Cardiac Monitor Tech will function in a supportive role to a registered nurse and work collaboratively with the health care team in the ... on staffing needs. Flex Team OA/MTs report to the Clinical Manager but daily activities are coordinated...communication with NEOPO and related paperwork in conjunction with RN . Screen calls for clinical team and… more
- Baystate Health (Springfield, MA)
- …incentive payments that may be applicable to this role.** **Summary:** Reports to the Nurse Manager but daily activities are coordinated by the charge nurse ... communication with NEOPO and related paperwork in conjunction with RN . Screen calls for clinical team and...by Zoned Hospitalist. Make available the unit based assignment ( RN /Case Manager /Social Worker as well as covering… more
- Baystate Health (Westfield, MA)
- **Summary:** Reports to the Nurse Manager but daily activities are coordinated by the charge nurse . Under direct supervision works with patient and family ... communication with NEOPO and related paperwork in conjunction with RN . Screen calls for clinical team and...by Zoned Hospitalist. Make available the unit based assignment ( RN /Case Manager /Social Worker as well as covering… more
- Commonwealth Care Alliance (Boston, MA)
- …such as Certified Information Privacy Professional (CIPP), Certified Information Systems Auditor (CISA), Certified Information Security Manager (CISM), and/or ... Accountability Act ("HIPAA"), Health Information Technology for Economic and Clinical Health Act ("HITECH"), the Genetic Information Nondiscrimination Act (GINA),… more
- Molina Healthcare (South Florida, FL)
- …activities and results to identify opportunities for improvement. + Surfaces to Manager and Director any gaps in processes that may require remediation. + ... Excel and Visio (flow chart equivalent). **Preferred Education** Preferred field: Clinical Quality, Public Health or Healthcare. **Preferred Experience** + 1 year… more
- Molina Healthcare (CA)
- …activities and results to identify opportunities for improvement. + Surfaces to Manager and Director any gaps in processes that may require remediation. + ... Excel and Visio (flow chart equivalent). **Preferred Education** Preferred field: Clinical Quality, Public Health or Healthcare. **Preferred Experience** 1 year of… more
- Molina Healthcare (NM)
- …activities and results to identify opportunities for improvement. * Surfaces to Manager and Director any gaps in processes that may require remediation. * ... Excel and Visio (flow chart equivalent). **Preferred Education** Preferred field: Clinical Quality, Public Health or Healthcare. **Preferred Experience** 1 year of… more