- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Medical Management Auditor - RN Location: Remote Career Area: Health Services ... of auditing and analysis to obtain operational quality within Medical Management for case management ,...other accountabilities as assigned. Required Skills and Experience ⦁ Registered Nurse licensure in MN. ⦁ 3+… more
- Molina Healthcare (Bellevue, WA)
- …required **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), ... Auditor performs auditing of clinical staff in Utilization Management (UM), Case Management (CM), Member Assessment...them. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and… more
- Elevance Health (Atlanta, GA)
- …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 (CDI, MS-DRG, AP-DRG and APR-DRG)**...MS-DRG, AP-DRG and APR-DRG)** is responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions… more
- US Tech Solutions (Newark, NJ)
- …of related experience, preferably in the healthcare industry. + **Active New Jersey Registered Nurse ( RN ) License required.** **Skills:** + Knowledge of ... potential extends or Convert** **Job Description:** + The HEDIS Nurse Auditor is responsible for conducting quality...managed care principles and medical terminology. + Familiarity with HEDIS guidelines and URAC… more
- Molina Healthcare (Bronx, NY)
- …, and/or managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... care. Essential Job Duties * Performs audits in utilization management , care management , member assessment, behavioral health,...* Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure member needs… more
- Mount Sinai Health System (New York, NY)
- …at all levels throughout the organization. **License** ? Current NYS licensure ( Registered Nurse ( RN ), Occupational Therapist (OT), Physical Therapist ... Technologist and related professions). ? Certifications such as Certified Professional Medical Auditor (CPMA), Certified Inpatient Coder (CIC), Certified Coding… more
- UPMC (Pittsburgh, PA)
- …(CIC) + Certified Evaluation & Management Coder (CEMC) + Certified Professional Medical Auditor (CPMA) + Certified Professional Coder (CPC) + Certified ... Medical Coder (CMC) + OR Registered Health Information...+ OR Licensed Professional Nurse (LPN) + Registered Nurse ( RN ) Required: + Act… more
- Humana (Corpus Christi, TX)
- … management as needed. Requires applicable State licensure in field of study: Registered Nurse ( RN ), Licensed Masters Clinical Social Worker (LCSW), ... accuracy, and Medicare Conditions of Participation demand meticulous documentation. A QA Auditor will help ensure all records meet federal, state, and payer-specific… more
- Marshfield Clinic (Marshfield, WI)
- …together to support the most exciting missions in the world!** **Job Title:** Nurse Auditor - Revenue Integrity (Remote in Wisconsin) **Cost Center:** 101651059 ... **_**Wisconsin residents only eligible to apply**_** **JOB SUMMARY** The Nurse Auditor - Revenue Integrity is responsible...are substantially related to the position._ **Minimum Required:** + Registered Nurse license awarded by the State… more
- UNC Health Care (Chapel Hill, NC)
- … Association) certification - AAPC (American Academy of Professional Coders) certification - RN ( Registered Nurse ) license - LPN (Licensed Practical ... the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides elbow to elbow support during training and education as well as… more