- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- Chenega Corporation (Rockville, MD)
- …Services Strategic Business Unit** company, is looking for a Physician- Contract Medical Reviewer (CMR) to support the Department of Health and Human Services (HHS), ... closely with the Government and Contractor team trainers, physicians, and nurse practitioners. + Support management, administration, data, communication, and other… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview: ;** The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory ... + Process appeals, ensuring compliance with all regulatory milestones + Review medical records to identify Hospital-Acquired Conditions (HAC), ensure proper… more
- Zelis (FL)
- …interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay ... AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest savings for… more
- Nuvance Health (Poughkeepsie, NY)
- …Must be available during weekday hours. 8a-5p *Purpose: *The Quality Systems Reviewer assists in the implementation of the Agencyi? 1/2s Performance Improvement, ... program dashboard on quality and process measures.Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as appropriate.… more
- PruittHealth (Norcross, GA)
- **RN certified in OASIS and ICD 10 Reviewer ** **- HOME HEALTH SERVICES** **Must have ICD-10 Certification** **Join the PruittHealth @Home family, where we deliver ... CERTIFICATION, AND EDUCATIONAL REQUIREMENTS** + Current, active, and unrestricted Registered Nurse (RN) licensure in the state of practice **Family Makes Us… more
- SSM Health (MO)
- …to clinical staff regarding these requirements during the concurrent record review process. + Maintains knowledge of mortality models, observed rate/expected rate ... (O/E ratios), industry trends, variable and diagnosis review group (DRG) frequency. + Serves as a liaison...- Regional MSO Credentialing + Or + Registered Professional Nurse (RN) - Illinois Department of Financial and Professional… more
- Kelly Services (Fargo, ND)
- …team: Proudly Serving Those Who Served** Are you a licensed MD, DO, Nurse Practitioner* (NP), or Physician Assistant* (PA) seeking meaningful work that fits ... Role** + Perform one-time veteran disability evaluations (DBQs/C&P exams) + Review health histories, assess whether injuries/conditions are likely service-related +… more
- Zelis (NJ)
- …Zelis standards regarding privacy What you'll bring to Zelis: + Registered Nurse licensure preferred + Inpatient Coding Certification required (ie, CCS, CIC, RHIA, ... RHIT) + 5+ years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims preferred + Solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers + Experience and working knowledge of Health… more
- Dignity Health (Chandler, AZ)
- …the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of ... Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… more