- UCLA Health (Los Angeles, CA)
- …and members. + Documents all review findings and decisions in the case management system and supports reporting initiatives. + Educates providers and staff ... Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role...and support the decision-making process. + Ensures compliance with CMS , state, federal, and UCLA Health standards. + Reviews… more
- Covenant Health Inc. (Knoxville, TN)
- …in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area's largest employer. Our more than 11,000 employees, ... serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes...needs and in accordance with the Joint Commission, HIPAA, CMS and other related State and Federal guidelines. ###@covhlth.com… more
- Bozeman Health (Bozeman, MT)
- …with electronic health records (EHR) systems (preferably Epic) and compliance/audit management tools. + Intermediate knowledge of CMS guidelines, payer ... supporting regulatory surveys/investigations and accreditation standards (eg, Joint Commission, CMS Conditions of Participation). + Experience in small to mid-size… more
- WelbeHealth (Pasadena, CA)
- …role in achieving our mission by performing skilled duties at home under CMS approval, bringing convenient and necessary care to our participants' homes. Under the ... after site licensure or in the event of pandemic/stay at home order with CMS approval to provide necessary care in the home. **Essential Job Responsibilities:** +… more
- Rochester Regional Health (Rochester, NY)
- …Days SUMMARY: Review all inpatient medical necessity denials for the health system based on InterQual and/or CMS guidelines. Responsibilities include managing ... Job Title: Registered Nurse I Department: Utilization Management Location: Rochester General Hospital Hours Per Week:...review the denials that do not meet InterQual and/or CMS guidelines for his/her recommendation regarding appeal options. +… more
- Robert Half Office Team (San Diego, CA)
- …Assist clients in navigating various systems, including Epic Software and Avaya CMS . * Support organizational goals by adhering to established protocols and ... (Word, Excel, PowerPoint). * Experience with tools like ADP, Epic Software, and Avaya CMS is preferred. * Bilingual in Spanish and English is highly desirable. *… more
- Avera (Aberdeen, SD)
- …matrix/patient estimator tools and posts payments correctly to the payment processing system . + Maintains customer relations at a very positive level as evidenced ... patients of telephone consumer protection act, insurance information, referring physicians, and CMS required documentation) such as IMMs, MOON, and OBVs, etc. +… more
- State of Michigan (MI)
- …Medical Director for Michigan Veteran Homes (Grand Rapids or Chesterfield), both CMS -certified 128-bed long-term care facilities. Direct operations of the Home for ... Please select your level of experience in following Centers for Medicaid and Medicare Services ( CMS ) for long-term care. + None + Less than 1 year of experience +… more
- Boehringer Ingelheim (Ridgefield, CT)
- …revenue management systems (eg, Model N), overseeing user training, system updates, and UAT requirements.Continuous Improvement & Special Projects: Identify and ... Value & Access, Commercial FP&A, and GTN to ensure data integrity, system accuracy, and alignment on pricing strategies. Provide government pricing impact… more
- ASM Research, An Accenture Federal Services Company (Arlington, VA)
- …meet call center target metrics + Ensures complete and accurate documentation in case management system ( CMS ) + Assists direct reports to deescalate callers, ... Cyber Awareness and PII to ensure access to the CMS system is maintained **Minimum Qualifications** +...to type 50 wpm + Excellent organization and time management skills + Comply with all HIPAA regulations +… more