- HCA Healthcare (Richmond, VA)
- …want to join an organization that invests in you as a Revenue Integrity Charge Review Analyst? At Parallon, you come first. HCA Healthcare has committed up to $300 ... opportunity to make a difference. We are looking for a dedicated Revenue Integrity Charge Review Analyst like you to be a part of our team. **Job Summary and… more
- Virginia Mason Franciscan Health (Silverdale, WA)
- …and overseeing multiple Virginia Mason Franciscan Health (VMFH) medical staff peer review programs and for supporting the activities of the medical staff processes ... Evaluations (FPPE) for practitioners who have been granted clinical privileges. Peer review is instrumental in identifying, tracking and supporting the resolution of… more
- Intermountain Health (Las Vegas, NV)
- …regulatory agencies standard, related to health care organizations, which includes Medicare coverage criteria. **Job Profile:** **This position is the primary for ... order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims...Performs medical review activities pertaining to utilization review , claims review , quality assurance, and medical… more
- Albany Medical Center (Albany, NY)
- …documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and contacts ... Demonstrates proper use of MCG and documentation requirements through case review and inter-rater reliability studies.* Facilitates removal of delays and documents… more
- Centene Corporation (Austin, TX)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers on utilization… more
- Intermountain Health (Murray, UT)
- …than 1 million members. Select Health's line of businesses (LOB) includes Medicare , Medicaid, FEHB, Marketplace Qualified Health Plans, fully funded and self-funded ... Commercial plans. Utilization Review nurses at Select Health proactively oversee inpatient and...applicable regulatory guidelines (NCQA, CMS, State) and ensures timely review with clear accurate communication to members and requesting… 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
- Houston Methodist (The Woodlands, TX)
- …patient satisfaction and safety measures. **FINANCE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource use, ... service focus and application of positive language principles + Knowledge of Medicare , Medicaid and Managed Care requirements + Progressive knowledge of community… more
- Intermountain Health (Springfield, IL)
- **Job Description:** Patient Account Associate II Credit Balance and Account Review Job Profile Summary Provides extraordinary care to our customers through ... activities (Billing & Follow-Up) required** . Knowledge of Medicaid and Medicare billing regulations required . Epic systems experience preferred **Physical… more
- Centene Corporation (New York, NY)
- …applicable criteria, and analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with State, Federal and NCQA ... and 2 - 4 years of related experience. Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. RN… more