- Houston Methodist (Houston, TX)
- …study budgets, coverage analyses, etc. - Performs detailed claims testing and medical review . - Reviews Medicare Coverage Analysis to ensure completion prior to ... competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees,… more
- Humana (Dover, DE)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will...daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more
- Humana (Charleston, WV)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to… more
- Alameda Health System (San Leandro, CA)
- …including response to payor requests for concurrent and retrospective review information including Medicare and MediCal regulations/requirements, avoidable ... notes and discharge summary related information as required by Medicare , MediCal, Title 22 and other mandated regulations according...in Case Management in an acute setting or utilization review at a medical group or health plan. Required… more
- PeaceHealth (Vancouver, WA)
- …+ Knowledge of discharge planning, health care reimbursement, utilization review processes and Medicare admission status/classification level. (Required) ... daily plan and the plan for the stay. Performs patient care review activities including monitoring and correcting patient status, documentation for medical necessity… more
- BAYADA Home Health Care (Orlando, FL)
- …while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit recommendations to each clinician to promote OASIS accuracy. ... Utilization Review , Quality Assurance, Remote, Home Health Coding, Coder, Medicare **As an accredited, regulated, certified, and licensed home health care… more
- Houston Methodist (Houston, TX)
- …reviews the filing of Federal and State Charity Report. + Directs the coordination, review and filing of Medicare and Medicaid cost reports and associated audits ... internal and external financial and governmental reporting requirements. Requirements include Medicare cost reports, Federal Tax Returns Health and Human Services… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Working under limited ... care. + Extrapolates and summarizes medical information for physician review or other external review . + Generates...self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans.… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I ... information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're working in… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR ... administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the largest… more
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