- Rochester Regional Health (Rochester, NY)
- …Safety. Required Licensure/Certification Active licensure in one of the following: + Preferred: Registered Nurse ( RN ) + Qualified: Licensed Practical ... Job Title: Injury Prevention Specialist ( RN )Department: Injury Prevention Location: Rochester General Hospital Hours...assessments and training on an ad hoc basis. + Review federal and state safety regulations to ensure program… more
- Trinity Health (Newtown Square, PA)
- …(BSN, AS or Diploma), or an Advanced degree in Medical Field + If RN , Current Registered Nurse License + Certified Coding Specialist (CCS), Certified ... consultant. Facilitates the overall quality, completeness, accuracy, and integrity of medical record documentation through extensive record review . Through… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …case planning and research, conducting onsite or desk audits, clinical reviews of medical records to ensure correct billing of services and appropriateness of care, ... Level I + Functions as a clinical reviewer of medical records, researching and investigating complex medical ...and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. +… more
- Sedgwick (Cedar Rapids, IA)
- … review of referred claims ; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. ... + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made on claims .… more
- HCA Healthcare (Caldwell, ID)
- …our multi-generational nursing family. We partner with our Nurses at West Valley Medical Center! **Job Summary and Qualifications** The RN Occupational Health is ... Heart Association Basic Life Support + Certified Occupational Health Nurse (COHN) preferred **Benefits** West Valley Medical ...career path, we encourage you to apply for our RN Employee Health opening. We review all… more
- Eastern Connecticut Health Network (Vernon, CT)
- …role is essential to the quality metrics of the agency. EDUCATION/ EXPERIENCE: + A Registered Nurse or Physical Therapist licensed in the State + Experience in ... and demonstrates the provision of skilled services. + Completes medical record review of patient records in...expectations + Ultimately responsible for the readiness of the claim for final release to billing. + The CDS… more
- Veterans Affairs, Veterans Health Administration (Lebanon, PA)
- …will also function as the Agency Medical Officer (AMO) and as the Medical Review Officer(MRO) who will review all employee screenings and intakes. ... ePerformance and credentialing reviews for 2 PA's and 2 RN 's. In addition to the regular duties of this...(1) Those approved by the Accreditation Council for Graduate Medical Education (ACGME), b) OR [(2) Those approved by… more
- CVS Health (New Albany, OH)
- …do it all with heart, each and every day. **Position Summary** **This Case Manager RN position is 100% remote and the employee can live in any state.** **Normal ... (1-2 times per quarter).** Typical training hours are Monday-Friday 8-4:30 EST. Nurse Care Manager is responsible for telephonically and/or face to face assessing,… more
- Centene Corporation (Lansing, MI)
- …Licensed Marital and Family Therapist (LMFT), Licensed Certified Social Worker (LCSW), Licensed Registered Nurse ( RN ), Acute Care Nurse Practitioner ... equivalent work experience within a managed care environment related to HEDIS record review , quality improvement, medical coding or transferable skill sets that… more
- Trinity Health (Syracuse, NY)
- …strongly preferred). + Master's degree preferred. + Certification (CPHRM) is preferred. + Registered Nurse preferred. + Ideally, the candidate will have 3-5 ... for the overall patient safety and clinical risk management functions related to review and response to reported events. Responds to crisis situations that have… more