- Insight Global (South Jordan, UT)
- …criteria, and coding terminology. Expert coding knowledge (DRG & ICD-10) Registered Nurse RN (must be inpatient) WITH coding/ clinical documentation certification ... Job Description Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100%...in clinical documentation) OR IF NOT A NURSE : Degree in RHIM, RHIA, RHIT with medical coding… more
- AdventHealth (Orlando, FL)
- …The Surgical and Procedural Services Safety and Regulatory Compliance Auditor evaluates the surgical and procedural environment, policies, and procedures ... and regulations. Responsible for performing routine readiness rounding in clinical areas to identify areas of opportunity and prepare...Florida or multi state license as a Licensed Practical Nurse **or** + RN current valid State of Florida… more
- CVS Health (Phoenix, AZ)
- …heart, each and every day. **Position Summary** The **Healthcare Quality Management Auditor ** participates in the development and ongoing implementation of QM ( ... to)** + Completes a variety of onsite medical and clinical audits for all lines of business, including AHCCCS...in QM meetings. **Required Qualifications** + Active RN (Registered Nurse ) or LPN (Licensed Practical Nurse ) license,… more
- US Tech Solutions (Newark, NJ)
- …months contract with potential extends or Convert** **Job Description:** + The HEDIS Nurse Auditor is responsible for conducting quality audits related to state ... to identify trends and facilitate quality improvement initiatives. + Assist with clinical studies, quality projects, and audits. + Lead and coordinate Corrective… more
- Molina Healthcare (Bronx, NY)
- JOB DESCRIPTION Job SummaryProvides support for healthcare services clinical auditing activities. Performs audits for clinical functional areas in alignment with ... in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with… more
- Centene Corporation (Jefferson City, MO)
- …the auditing of corporate, health plan, and specialty company staff related to clinical systems entry and/or processes + Develop and maintain the audit process and ... audit errors + Coordinate auditing outcomes and system maintenance with the Sr. + Clinical Systems Specialist to resolve or enhance clinical systems + Performs… more
- Naven Health (Nashville, TN)
- …Assurance Chart Review Nurse is responsible for the review of assigned clinical records. The Quality Assurance Chart Review Nurse works closely with the ... to identify documentation discrepancies and deficiencies in the patient's clinical records. The Quality Assurance Chart Review Nurse...Interests (PQIs)** + Previous experience as a Quality Assurance Nurse or Chart Review Auditor + Knowledge… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …drivers. Essential Accountabilities Level I + Handles physical health member clinical management programs. + Maintains knowledge of current Case Management Society ... or external referral sources. Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management… more
- SSM Health (MO)
- …Summary:** Performs as a vital member of the interdisciplinary care team member, an auditor , and an educator ensuring medical records are complete and clinical ... and electronic health record charts that accurately capture the clinical picture. **Job Responsibilities and Requirements:** PRIMARY RESPONSIBILITIES + Reviews… more
- St. Luke's University Health Network (Allentown, PA)
- …or coding determination made by the government or commercial payors, or their auditor representative. + Facilitate clinical chart reviews to assist with ... regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and… more