- General Dynamics Information Technology (Fairfax, VA)
- …**Job Family:** Administration **Skills:** Affordable Care Act (ACA),IT Incident Management ,Root Cause Analysis (RCA),Salesforce (Software) **Experience:** 5 + years ... into opportunity. Our work depends on a Salesforce Incident Management Analyst joining our team to support the Centers...to support the Centers for Medicare & Medicaid Services ( CMS ) activities. Work visa sponsorship will not be provided… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …accuracy, medical necessity, and billing code selection in alignment with CMS , OIG, and other applicable professional and technical services regulations and ... 3 years of experience in a healthcare coding environment. Knowledge of CMS (Medicare and Medicaid) and commercial payers billing and documentation guidelines… more
- Humana (Washington, DC)
- …by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, ... of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise from inpatient or post-acute care… more
- Baylor Scott & White Health (Dallas, TX)
- …Health. Responsible for the accuracy and integrity of the credentialing database system . Functions as a Coordinator Credentialing to assure optimum performance of ... of Healthcare Organizations (TJC) and Center for Medicare and Medicaid Services ( CMS ) and other regulatory agencies as they pertain to medical staff and… more
- 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