- HCA Healthcare (Salt Lake City, UT)
- …+ 2 or more years of clinical experience preferred. + Knowledge of Utilization Review , DRG review , and Discharge Planning preferred. For 150 years, ... as conduct psychotherapy process groups. SW-MSW also perform utilization review functions, including conducting InterQual reviews and obtaining insurance… more
- Centene Corporation (New York, NY)
- …respond to ICD-10 coding changes and its effect on inpatient claims payment. Chart review will include DRG pre-payment review , hospital readmission review ... and outlier payment review . + Analyze moderately complex health care information; reviews medical records; integrate medical coding and reimbursement rules; provide pricing guidance. + Ensure medical coding rules and regulations including compliance… more
- Texas Health Resources (Arlington, TX)
- …best practices for areas vulnerable to compliance errors. Denial Support & Case Review - Conduct additional reviews to assist departments handling Medicare, OIG, or ... are resolved within the stipulated time frame. Other duties as assigned. Review , Auditing, and Monitoring Conduct Compliance Audits - Perform internal audit testing… more
- University of Southern California (Arcadia, CA)
- …and other clinical staff. + Meets established productivity targets for record review and appropriate query placement. + Demonstrates working knowledge of ICD-10 CM ... Medicare Part A and how the regulatory requirements impact DRG assignments. + Minimum of three years' experience in...experience in clinical disciplines (RN, MD, FMG) or utilization review /case management in an acute care facility, with clinical… more
- Datavant (Lincoln, NE)
- …overall 95% coding accuracy rate and a 95% accuracy rate for MS- DRG assignments + Maintain site-specific productivity benchmarks + Foster professional communication ... medical facility. + Experience with significant level of coding quality review feedback + Experience in computerized encoding and abstracting software **What… more
- CareFirst (Washington, DC)
- …Onsite Clinical Navigator (RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely and smooth transition ... level of care. Applies sound clinical knowledge and judgment throughout the review process. Follows member benefit contracts to assist with benefit determination. +… more
- University of Utah (Salt Lake City, UT)
- …External Posting **Pay Rate Range** $70,000 - $100,000 **Close Date** 02/13/2026 **Priority Review Date (Note - Posting may close at any time)** **Job Summary** ... processes. Recommends enhancements to policies and procedures for compliance review . * Designs and implements training and education program...and B), and ICD -10, CPT , HCPCS , DRG coding; proficient with word processing, spreadsheet and related… more
- CareFirst (Baltimore, MD)
- …Onsite Clinical Navigator (RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely and smooth transition ... level of care. Applies sound clinical knowledge and judgment throughout the review process. Follows member benefit contracts to assist with benefit determination. +… more
- The Cigna Group (Bloomfield, CT)
- …recommendations to business partners at various levels of the organization + Review tools and reports available to matrix partners (Network Analytics, Competitive ... business needs (eg, Underwriting Discount Guarantee support, Network Analytics/Med Econ review process) + Assist in the development of uniform data submissions… more
- Houston Methodist (Houston, TX)
- …many of the following: organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of staff performance, ... customer requests. Responds promptly and appropriately to requests to code or review coded accounts for accuracy. Serves as liaison between team members, management… more