- Elevance Health (Chicago, IL)
- …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... **Diagnosis Related Group Clinical Validation Auditor - RN ** **Location:** This position will work...** **Location:** This position will work a hybrid model ( remote and office). Ideal candidates will live within 50… more
- Elevance Health (Tampa, FL)
- **Provider Auditor ** _This position will work a hybrid model ( remote and office), 1 time per week. The Ideal candidate will live within 50 miles of one of our ... to recover, eliminate and prevent unnecessary medical-expense spending. The **Provider Auditor ** conducts on-site reviews of medical charts, medical notes, itemized… more
- Ochsner Health (New Orleans, LA)
- …management. Performs and documents audits and presents oral and written conclusions to the Lead Nurse Auditor and department management. Educates and assists ... Required - Certification as CPC, CCS, CHC, RHIA, RHIT, RN , or LPN or other related certification. **Knowledge Skills...through auditing and monitoring or other means to the Lead Nurse Auditor and/or designated… more
- Elevance Health (Seven Fields, PA)
- **JR150201 Behavioral Health Clinical Quality Auditor Analyst Sr** The Behavioral Health Clinical Quality Audit Analyst Sr is a professional-level clinical ... Committee when needed. + Complete onsite as well as remote chart audits for a variety of levels of...Skills, Capabilities, and Experiences:** + Active PA, LCSW, LBS, RN , LPC, LMFT, or LSW licensure is needed per… more
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Lead medical record audits, monitor and analyze clinical documentation, and ... provider performance and quality of care through clinical case reviews. + Lead clinical audits for provider medical records both remotely via electronic medical… more
- Molina Healthcare (Phoenix, AZ)
- …strategic team to present and evaluate intervention strategies. **Only individuals with an RN license are being considered at this time.** + Plans and/or implements ... to improve care and service. + Serves as operations and implementation lead for Molina Plan quality improvement interventions using a defined roadmap, timeline,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... NYS DOH, CMS, NCQA, and HEDIS, serving as internal auditor within the group. + Responsible for all aspects...Associates degree required. Bachelor's degree preferred. + Active NYS RN or Registered Dietician or Physical Therapist… more
- Molina Healthcare (Everett, WA)
- …+ Performs the lead role of the HEDIS medical record review overreader/ auditor which includes ongoing review of records reviewed and data entered by the ... **Job Description** **Job Summary** Molina's Quality Improvement Lead Overreader conducts oversight and audits of the data collected and abstracted from medical… more
- Ochsner Health (New Orleans, LA)
- …Works with the clinical providers , on- site case management team, as well as LPN/ RN or Nurse Auditor in the Pre-Service department. + Performs Pre-Service ... has never changed - our commitment to serve, heal, lead , educate,** **and innovate. We believe** **that every award...work from the following areas are not eligible for remote work position_ _: Colorado, California, Hawaii, Illinois, Maryland,… more