- UNC Health Care (Chapel Hill, NC)
- …the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides elbow to elbow support during training and education as well as ... all patients. Educates on proper creation of provider compliant queries. 8. Ensures compliance with third party and State and Federal regulations. 9. Audits CDS… more
- Molina Healthcare (Phoenix, AZ)
- …activity and provides direction and implementation of federal/state quality management compliance activities. Supports the creation and ongoing revision of policies ... of the quality program and day-to-day work processes to support compliance with state contracts, policies, and program requirements + Evaluates project/program… more
- Kelly Services (Lake Mary, FL)
- …(NAE) will assist in the development, administration, and oversight of the Nurse Aide Evaluator Training Program, ensuring compliance with contractual ... in the development, management, and maintenance of NAE quality assurance programs in compliance with Company Nurse Aide LLC standards. Ensure quality assurance… more
- R1 RCM (Chicago, IL)
- …AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to draft ... you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal...a Clinical Validation Review by an insurer or third-party auditor . + Draft appeal letters that are well-written, logically… more
- AdventHealth (Altamonte Springs, FL)
- …with physicians, nursing and HIM coders. The CDI Quality & Compliance Team Leader strategically facilitates and obtains appropriate and quality physician ... practitioners, nursing, care management and quality abstracters. The Quality Auditor Manager adheres to strict departmental and organizational goals, objectives,… more
- Sharp HealthCare (San Diego, CA)
- …National Association for Healthcare Quality; HPCC Certified Hospice and Palliative Nurse (CHPN) - Hospice and Palliative Credentialing Center; HPCC Certified Hospice ... Administrator (CHPCA) - Hospice and Palliative Credentialing Center; California Registered Nurse (RN) - CA Board of Registered Nursing; Bachelor's Degree **Hours**… more
- The Cigna Group (Sacramento, CA)
- …**Job Description Summary** Provides advanced professional input to complex Nurse Case Management assignments/projects. Plans, implements, and evaluates appropriate ... and acumen to develop models and procedures, and monitor trends, within Nurse Case Management. RN and current unrestricted nursing license required. **Job… more
- HCA Healthcare (San Antonio, TX)
- …true discrepancy and complete incident reports as required. You will review RX Auditor report and generate investigation reports for nurse managers/directors to ... hospital personnel politely and appropriately. You will perform and monitor compliance for quality control and performance improvement functions as assigned. You… more
- PeaceHealth (Vancouver, WA)
- …review of all OASIS/HIS admission documents and Plan of Care to ensure CMS program compliance is met. Works closely with the System Manager of Quality for Home & ... & Community leadership, and Senior Quality Facilitator to promote regulatory compliance and excellent patient outcomes and reimbursement. Serves as a consultant,… more
- Covenant Health Inc. (Knoxville, TN)
- …Covenant Health standards of Telephone Excellence policy. + Refers patient accounts to nurse auditor upon request by patient or insurance company, and monitors ... guidelines and other Third Party Payor requirements assuring departmental compliance . + Recognizes situations, which necessitate supervision and guidance, seeks… more