• Revenue Integrity Clin Charge Review

    HCA Healthcare (Richmond, VA)
    …Do you have the career opportunities as a Revenue Integrity Clinical Charge Review Analyst RN you want with your current employer? We have an exciting ... of colleagues. Do you want to work as a Revenue Integrity Clinical Charge Review Analyst RN where your passion for creating positive patient interactions is valued?… more
    HCA Healthcare (03/22/25)
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  • Revenue Integrity Charge Review Analyst

    HCA Healthcare (Bowling Green, KY)
    …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
    HCA Healthcare (05/29/25)
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  • System Utilization Management SUM Utilization…

    Alameda Health System (Oakland, CA)
    …(eg, inpatient, observation, outpatient). 3. Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet ... System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General...Ensure compliance with federal, state, and organizational regulations, including Medicare and Medicaid guidelines. 7. Stay informed about CMS… more
    Alameda Health System (05/23/25)
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  • Utilization Review Specialist

    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
    HonorHealth (05/11/25)
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  • Peer Review RN Program Manager

    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
    Virginia Mason Franciscan Health (04/21/25)
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  • Utilization Review Medical Director

    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 ... are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims review , quality… more
    Intermountain Health (03/04/25)
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  • Access Service Representative-SRN Float Pool-Sharp…

    Sharp HealthCare (San Diego, CA)
    …coverage through MCA for SRS/SCMG and MPV (or Portal) for potential Medicare or Medi-Cal.Use Coordination of Benefits (COB) standards to prioritize billing order ... of insurance plans. Medicare patients - Medicare Secondary Payer (MSP)...Maintenance Organizations (HMO) patients. Notify the clinical staff, including physician , on patients that are out-of-network.Follow process to estimate… more
    Sharp HealthCare (03/09/25)
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  • Case Manager (RN) - Utilization Review

    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
    Houston Methodist (05/30/25)
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  • Patient Account Assoc II Credit Balance & Account…

    Intermountain Health (Boise, ID)
    …equivalent (GED) required + One (1) years of experience in hospital or physician back-end revenue cycle (Payment Posting, Billing, Follow-Up) required + Knowledge of ... Medicaid and Medicare billing regulations required + Two (2) years of...+ Two (2) years of experience in hospital or physician insurance related activities (Authorization, Billing, Follow-Up, Call-Center, or… more
    Intermountain Health (05/28/25)
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  • Medical Director - Care Plus - Florida

    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 (04/24/25)
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