• Medical Investigator I/II (RN Required)

    Excellus BlueCross BlueShield (Rochester, NY)
    …Conduct/NYS Education Department, Office of Professional Discipline and/or internal referral for quality review by the applicable business area. + Acts as ... agencies. Essential Accountabilities: Level I + Functions as a clinical reviewer of medical records, researching and investigating complex medical cases. Interprets… more
    Excellus BlueCross BlueShield (09/17/25)
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  • Director - Case Management Medical Review

    Lilly (Indianapolis, IN)
    …timelines. Including: + Ensuring medical validity of ICSRs; + Accountable for the review and accuracy of narratives, coding , and assessments of seriousness, ... life better for people around the world. **Purpose:** The Case Management Medical Review Scientist is responsible for conducting comprehensive medical review of… more
    Lilly (11/13/25)
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  • Rev Integrity Auditor Sr

    Covenant Health Inc. (Knoxville, TN)
    …11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we ... Summary: Performs complex level professional internal auditing work. Work involves compliance audit projects for Covenant Health entities as they relate to charging,… more
    Covenant Health Inc. (11/14/25)
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  • Market Director Population Health Quality…

    Catholic Health Initiatives (Little Rock, AR)
    …zones, and up to 25-50% professional travel may be involved. + Supports quality , clinical practice, safety, risk coding , compliance, patient experience and ... functions within the Value Hub (Clinically Integrated Networks/CINs). + Facilitates quality and patient experience performance across the SE Region Value Hub… more
    Catholic Health Initiatives (11/15/25)
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  • Outpatient Surgical and Claims Edit Auditor

    Cedars-Sinai (Los Angeles, CA)
    …local, State, and Federal Coding Guidelines. Duties include: + Performs quality coding reviews or audits within established departmental productivity and ... accuracy standards. Assists with processing re-bills post coding audit changes and assists with ...coding newsletter, provide basic level trending or data review for opportunities. + Evaluate codes through data reports… more
    Cedars-Sinai (11/25/25)
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  • Compliance Education Manager

    Weill Cornell Medical College (New York, NY)
    …audit findings into targeted education, addressing root causes of documentation and coding deficiencies. + Manage and track Compliance Audit Reports and ... The Compliance Education Manager plays a critical role in aligning education and audit strategies to support the compliance framework. This role is responsible for… more
    Weill Cornell Medical College (11/08/25)
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  • Clinical Quality Assurance Specialist- SF…

    Good Samaritan (Sioux Falls, SD)
    …related to the quality risk and risk score adjustment programs. Assist with the quality improvement review and audit related to potential quality ... Experience and knowledge of accreditation and regulatory agency standards preferred. Quality , medical coding , and/or risk adjustment experience is preferred.… more
    Good Samaritan (10/18/25)
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  • DRG Auditor - January Class

    Insight Global (South Jordan, UT)
    … principles, clinical guidelines, and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines, ... background in either facility-based nursing, clinical documentation, and/or inpatient coding and has a high level of understanding of...management team. Achieves the expected level of accuracy and quality set by the audit for the… more
    Insight Global (11/08/25)
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  • Quality & Risk Adjustment Specialist

    Avera (Sioux Falls, SD)
    …(RA) initiatives and Healthcare Effectiveness Data Information Sets (HEDIS). The Quality and Risk Adjustment Specialist will work closely with the Director ... of Quality and Risk Services, Manager of Risk Adjustment, Manager...rationale behind Risk Adjustment Work with physicians, clinic staff, coding , and other Health Plans staff to resolve … more
    Avera (10/28/25)
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  • VP Health Information & Revenue Integrity

    Novant Health (Charlotte, NC)
    … coding audits, Health Information Management, Revenue Integrity, Charge Capture, Utilization Review and Provider coding support services. This leader will be ... leadership, and operations support for clinical work such as utilization review , coding , clinical documentation improvement, health information management,… more
    Novant Health (11/15/25)
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