- UNC Health (Chapel Hill, NC)
- …email, data base tasks, or other electronic communication and via telephone.Responsibilities:1. Clinical Review Process - Uses approved criteria and conducts ... we serve.RN Utilization Manager position specifically for a Utilization Manager/ Clinical Appeals Nurse . This person is based...admission review /status change review within 24 hours of… more
- BAYADA Home Health Care (Fayetteville, NC)
- BAYADA Home Health Care is currently seeking a full-time Registered Nurse to become our next Clinical Manager in our Medicare certified Fayetteville Visits ... office in Fayetteville, NC. As one of the Clinical Managers, you will lead the field staff in...Associates and field staff Orientation of field staff Documentation review , including OASIS and Home Care Home Base (HCHB)… more
- University of New Mexico - Hospitals (Albuquerque, NM)
- …monitors, promotes and evaluates, in collaboration with the Trauma Medical Director the clinical aspects of the Trauma program to ensure quality trauma patient care ... to monthly: Multidisciplinary Quality Improvement (MDQI) Committee, Trauma Case Review /Peer Review Committee, Trauma Performance Improvement Committee (TPIC),… more
- R1 RCM (Salt Lake City, UT)
- …automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to draft ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and… more
- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview The Clinical Coding and Audit Specialist monitors, responds and performs the clinical coding and audit ... needed with appropriate staff and/or department for correction + Review coding to ensure documentation is completed...timely, compliant documentation that drives accurate billing Qualifications + Clinical review positions will require a RN… more
- Northwell Health (Garden City, NY)
- …RN - BSN or MSN candidates with a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist- Clinical . Conducts Home Health Resource ... standards are maintained in compliance with Federal and State regulations. + Applies coding rules and regulations to the validation review process. + Reviews… more
- UNC Health Care (Chapel Hill, NC)
- …and Wyoming.** Summary: This position trains and audits Inpatient and Outpatient Clinical Documentation Specialists (CDS) across all HCS entities that are owned or ... shared services. This position reports to the HCS Supervisor Coding and CDI Quality and Training. This position may...across the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides elbow to… more
- Elevance Health (St. Louis, MO)
- ** Clinical Review Nurse I -...+ Proficient in basic math calculations with percentages. + Coding certification or experience with medical coding is ... Friday 8 am - 5 pm EST or CST. Hours are flexible.** The ** Clinical Nurse Reviewer I** is responsible for reviewing and making medical determinations as to… more
- Hackensack Meridian Health (Hackensack, NJ)
- …diagnosis and the impact on severity of illness and Risk of Mortality. + Provides clinical expertise and references to the coding staff as needed. + Utilizes ... Office and Google Suite platforms. **Licenses and Certifications Required:** + Certified Coding Specialist. + NJ State Professional Registered Nurse License.… more
- Northwell Health (Lake Success, NY)
- …standards are maintained in compliance with Federal and State regulations. + Applies coding rules and regulations to the validation review process. + Reviews ... substantiated by the documentation in the Medical Record. Job Responsibility + Leverages clinical expertise to identify and validate DRG code assignment + Full … more
- UPMC (Harrisburg, PA)
- …payers. Interact with physicians regarding clarifications necessary for appropriate coding and clinical documentation standards. **Responsibilities:** + Adhere ... This CDI Coding Lead is a hybrid opportunity that oversees...necessary hospital groups/departments. Ensure accuracy and timely input of clinical documentation to support severity of illness and risk… more
- Geisinger (Wilkes-Barre, PA)
- …methodology in which to clarify existing documentation. Acts as a liaison between the clinical and coding functions. Provides education to the medical staff and ... a rewarding, lasting career with impact. Job Duties The Clinical Documentation Improvement Program (CDI) is designed to improve...highly trained staff members to perform a concurrent inpatient review of the record. This allows the record to… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of the Utilization Review Team and ... reviewing claims disputes and retrospective requests for services requiring clinical review prior to payment. The Utilization... review prior to payment. The Utilization Review Nurse will use appropriate governmental policies… more
- Vatica Health (Atlanta, GA)
- …our diverse team. The RN Clinical Coder- Nurse Auditor will independently review cases, ensuring accurate ICD-10-CM risk adjusted coding and clinical ... Responsibilities + Independently reviews cases, ensuring accurate ICD-10-CM risk-adjusted coding and clinical documentation. + Responsible for...Requirements + Must have minimum of 3 years of clinical experience as a Registered Nurse (RN)… more
- Molina Healthcare (TX)
- …are seeking a REGISTERED NURSE (RN) with prior experience in Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. MULTI STATE ... decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical… more
- Fresenius Medical Center (Reno, NV)
- …FEATURES:** Sign On Bonus Available!! Sign On Bonus Available Outpatient Dialysis Clinical Manager - position requires licensed Registered Nurse with minimum ... section for full details. **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure...+ Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding… more
- Ascension Health (Wichita, KS)
- …documentation issues prior to patient's discharge. + Maintain accurate records of review activities, ensuring reports and outcomes of clinical documentation ... documentation. + Complete admission reviews and work closely with coding staff to ensure accuracy in code assignments that...ensure accuracy in code assignments that reflect the patient's clinical status and care. + Initiate and maintain extensive… more
- Fresenius Medical Center (Newport News, VA)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... **POSITION FEATURES:** up to $15,000 SIGN ON BONUS!! Clinical Manager - Outpatient Dialysis Position will require...+ Accountable for completion of the Annual Standing Order Review and ICD coding . + Checks correspondence… more
- Martin's Point Health Care (Portland, ME)
- …as a "Great Place to Work" since 2015. Position Summary Job Description The Utilization Review Nurse works as a member of a team responsible for ensuring the ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well as… more
- CDPHP (Albany, NY)
- …The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior authorization. This includes ... reviews for acute and subacute rehabilitation, transportation and DME requests. Review of identified high-cost admissions and extended stays and inpatient… more
