- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical necessity and level of care using...failure of the progression of care process. + Conducts chart audits and performs peer-to-peer evaluations for continuous quality… more
- State of Indiana (Evansville, IN)
- …for Medicare & Medicaid Services certification as a Psychiatric Medicare /Medicaid Hospital. Role Overview: The Utilization Review Coordinator performs duties ... Utilization Review Coordinator-LPN Date Posted: Jul 18, 2025 Requisition...the chair for the Utilization Committee. This position completes chart reviews for new admissions, completes 30 day reviews,… more
- HCA Healthcare (Tampa, FL)
- …to join an organization that invests in you as a Pro Fee Coding Quality Review Educator? At Parallon, you come first. HCA Healthcare has committed up to $300 million ... are looking for a dedicated Pro Fee Coding Quality Review Educator like you to be a part of...of unique coding requirements for major payers such as Medicare , Medicaid, HMO's, PPO's, IPA's, employers, etc. + Demonstrate… 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
- Sharp HealthCare (La Mesa, 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)...medical records and facilitate transfers from/to outside facilities.Create patient chart for physician and organize charts for the HIM… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Supports corporate and ... lifecycle processes for all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including HEDIS audit submission, Consumer Assessment… more
- Bassett Healthcare (Cooperstown, NY)
- …functions, and or provides orientation as requested by supervisors for new employees. Patient Flow/ Chart Review Performs chart review in preparation for ... arrival prior to patient appointment as measured by supervisory observation. Based on chart review , ensures all necessary equipment and supplies are available… more
- Penn Medicine (Philadelphia, PA)
- …PENN Chart to truthfully demonstrate current state discovered via chart review , discovery of qualities needing further provider clarification, abstraction ... Physician or designee requesting appropriate documentation + Ongoing concurrent chart review , identification of complications and co-morbidities, collaboration… more
- Elevance Health (Waukesha, WI)
- …including associated reporting and KPIs. + Oversees design and execution of provider/ chart review workflows to ensure high quality encounter submissions. + ... of 5 years of related experience, including 3 years of hands-on HCC coding, chart review , and RAF calculations; or any combination of education and experience… more
- St. Luke's University Health Network (Hamburg, PA)
- …education of network policy on Patient Identification including Mark for Merge, Chart Corrections, and Patient Look-Up. + Responsible for the patient registration ... related to registration. Can require contacting provider office, reviewing patient medical chart for diagnosis and medical necessity information. + Required to cross… more