- Sutter Health (Sacramento, CA)
- …acuity and risk for mortality, in addition to Direct Report Groups ( DRG ) assignment. **Job Description** : **EDUCATION:** + Doctorate: Graduate of an accredited ... a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some...Sub-acute, Acute rehab. + Proficient Knowledge of coding and DRG assignment process preferred. + Must be able to… more
- RWJBarnabas Health (Oceanport, NJ)
- …responsible for ensuring accuracy and integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient encounters for other payers (not Medicare/Managed Medicare). ... and integrity of ICD-10-CM/PCS, CPT coding when applicable and DRG assignment for adherence to Federal and State Regulations...a team with other Quality Officers to ensure SMART review goals are met for all RWJBarnabas facilities. +… more
- Marshfield Clinic (Marshfield, WI)
- …Uniform Hospital Discharge Data Set (UHDDS) and assignment of the appropriate MS- DRG (Medicare Severity-Diagnosis Related Group) or APR- DRG (All Patients Refined ... co-morbidities and complications, secondary conditions, surgical procedures and/or other procedures. + MS- DRG /APR- DRG + Present on admission indicators + HAC… more
- Centene Corporation (New York, NY)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
- St. Luke's University Health Network (Allentown, PA)
- …records identified by RAC/MIC/CGI/QIO and other outside auditors in retrospective reviews for DRG and coding-related issues. May participate in review of other ... all diagnosis and procedure codes to assure properly assigned MS- DRG for the purposes of appealing proposed MS- DRG...MS- DRG for the purposes of appealing proposed MS- DRG and coding changes by insurance providers or their… more
- Houston Methodist (FL)
- …of clinical documentation. This position analyzes medical records for DRG 's, complications, and comorbidities; identifies trends; and notes observations and ... and follows up as necessary. Tracks responses and trends completion of DRG /Documentation worksheets as pertinent to scope of department. + Conducts follow-up reviews… more
- HonorHealth (AZ)
- …it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of health care services ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Guidehouse (Escondido, CA)
- …reflective of current CMS or other regulatory standards. + Conducts daily, concurrent review of inpatient records on assigned unit(s) to ensure complete and accurate ... assigned unit, perform initial code assignment for a working DRG and complete CDI software data entry for initial...Communicates to the CDI Coordinator when volume of daily review assignments is too high or low so that… more
- University of Michigan (Ann Arbor, MI)
- …Coder Inpatient Apply Now **Job Summary** Advanced coding position that requires review of medical record documentation and accurately assigns ICD-10-CM, ICD-10 PCS, ... as well as assignment of the Medicare Severity Diagnosis Related Group, (MS- DRG ) / All Patient Refined - Diagnosis Related Group, (APR- DRG ) based on payor… more
- Kaleida Health (Buffalo, NY)
- …Management, Quality Department and ancillary staff to perform concurrent analytical review of clinical documentation and coding data.The CDS facilitates obtaining ... an accurate reflection of the patient condition in the associated DRG assignments, case-mix index, documentation/coded quality metrics, and reimbursement. The CDS… more