- Elevance Health (Gilbert, MN)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be ... background. **Preferred Skills, Qualifications, and Experiences:** + Fraud and Abuse experienced Nurse with a CPC are highly desired. For candidates working… more
- Alameda Health System (Oakland, CA)
- …using adult learning principles. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California; & Basic Life ... AHS Policies and Procedure prior to final approval by Clinical Practice Council ( CPC ). + Participates in...+ Participates in continuing education provider unit as a Nurse Planner; utilizes Board of Registered Nursing… more
- Independent Health (Buffalo, NY)
- …regulatory standards, clinical criteria, and member benefit contract. **Qualifications** + Registered Nurse ( RN ) with active, current, unrestricted NYS ... benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Clinical Reviewer will be responsible for the collection and review… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Position Purpose: The Clinical Reviewer serves as a subject matter expert in the clinical review of claims, claim disputes, appeals and FWA special ... investigations Responsibilities: + Review of facility claim disputes including clinical ...Qualifications: + Minimum 5-7 years of experience as a clinical reviewer of facility claims in a… more
- Cedars-Sinai (Los Angeles, CA)
- …Los Angeles Fair Chance Initiative for Hiring. **Req ID** : 10457 **Working Title** : Registered Nurse - Clinical Documentation Specialist - 8 Hour Days ... care field preferred Foreign trained MDs will be considered License/Certifications: Registered Nurse , LVN, Occupational Therapist, Physical Therapist, Physician… more
- WMCHealth (Valhalla, NY)
- …departments. + Identify pre-bill and post-bill claim edits involving any type of clinical or coding review or required modifier based on services rendered. ... Sr. Revenue Integrity Analyst (CCS/ CPC /CCA/RHIT) - On-site position Company: NorthEast Provider Solutions...appealed in a timely manner. Coordinating appeal discussions with clinical & third party payors. + Develop, Implement and… more
- Cedars-Sinai (CA)
- …as a condition of continued employment. **Req ID** : 11005 **Working Title** : Registered Nurse - Lung Transplant Coordinator - Remote ON CALL **Department** : ... **Job Description** Are you ready to bring your clinical skills to a world-class facility recognized as...team, you will screen initial calls from the OPO, review and manage the EHR candidate wait list, … more
- Elevance Health (Seattle, WA)
- …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 ** **Virtual:** This role...are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical … more
- LA Care Health Plan (Los Angeles, CA)
- …of Microsoft Office suite, including Word, Excel and PowerPoint. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Payment Integrity Nurse Coder RN III Job Category: Clinical Department:...policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The… more
- Centene Corporation (Cheyenne, WY)
- …organization or acute care hospital. **For Fidelis Care only:** One year of experience in a clinical setting or acute care hospital; RN , PA, MD, APRN, DO or MBBS ... respond to ICD-10 coding changes and its effect on inpatient claims payment. Chart review will include DRG pre-payment review , hospital readmission review … more
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