Medical Claim Review Nurse Integrated Resources, IncMedical Claim Review NurseDallas, TXRemoteRequired Years of Experience: · Requires a minimum of 2 years of experience in inpatient payment integrity medical claim review including DRG Validation or Itemized Bill Review, including 2 years’ experience working with ICD-10, MS-DRG, AP-DRG and APR-DRG, CPT, HCPCS; or any combination of education and experience, which would provide an equivalent background. Clinical Validation Reviewer: Performs focused clinical reviews of inpatient and outpatient claims to verify that coded diagnoses, procedures, revenue codes, and corresponding reimbursement methodologies accurately reflect the patient’s documented clinical condition, services rendered, and billed charges.
Talent Acquisition Partner, Hospice Wheeler Staffing PartnersTalent Acquisition Partner, HospiceDallas, TXRemoteWheeler Staffing Partners partners with leading healthcare organizations to connect experienced recruiting professionals with rewarding career opportunities. The ideal candidate has recent Home Health or Hospice recruiting experience , a strong background recruiting RNs, and a proven ability to manage full-cycle recruitment.
NewRevenue Cycle Auditor RN - Revenue Integrity - Full time, Day, Remote Providence Health & ServicesRevenue Cycle Auditor RN - Revenue Integrity - Full time, Day, RemoteTXRemoteRequsition ID: 457901 Company: Providence Jobs Job Category: Revenue Cycle Operations Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Day Career Track: Nursing Department: 4001 SS RC REV INTEGRITY Address: CA Irvine 15480 Laguna Canyon Rd Work Location: Providence System Offices Discovery Park-Irvine Workplace Type: On-site Pay Range: $See Posting - $See Posting The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Case Management Supervisor RN CorVel CorpCase Management Supervisor RNDallas, TXRemote$77,960–$120,368 / yearPay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. The Case Management Supervisor is responsible for directing the operations of their designated department, which may include one or more of the following functions: human resources, customer service, and limited sales management.
NewDirector Of Sales & Business Development Harris Computer SystemsDirector Of Sales & Business DevelopmentRhode Island, TXRemote$80,000–$110,000 / yearYou'll work alongside experienced professionals, including a professional services team comprised of Registered Nurses and former perioperative staff, who bring deep clinical expertise and a customer-centric perspective to every challenge. About Picis: Join Picis, a global leader in perioperative and critical-care information systems, where you'll be part of a team that is genuinely pleased with their colleagues and thrives in a positive, comfortably fast-paced environment.
RN Care Manager – Cardiac SeamlessassistRN Care Manager – CardiacDallas, TexasRemoteThis is a full-time, remote, hourly contract position focused on delivering advanced clinical support through clinical triage, care plan development, and high-risk care management, including Transitional Care Management (TCM), Principal Care Management (PCM), Complex Care Management (CCM), Remote Patient Monitoring (RPM), and other applicable clinical programs. CCA is seeking experienced Registered Nurse (RN) Care Managers to support a high-acuity population of patients with complex cardiac conditions, including congestive heart failure (CHF) and other comorbidities.
Director, CERIS Audit CorVel CorpDirector, CERIS AuditFort Worth, TXRemote$99,250–$166,777 / yearPay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. EDUCATION & EXPERIENCE: Bachelors degree in Healthcare, Business Administration, or a related field; or 7+ years of equivalent education and experience in operations management and third-party healthcare audit services.
RN, Telephone Triage, Weekends (Remote) Cook Children's Health Care SystemRN, Telephone Triage, Weekends (Remote)Fort Worth, TXRemoteAbout Us: Cook Children's Medical Center is the cornerstone of Cook Children's, and offers advanced technologies, research and treatments, surgery, rehabilitation and ancillary services all designed to meet children's needs. Collaborates with callers on the telephone and with colleagues in other health disciplines to meet the individual health and illness needs of the patient and family.
NewItemization Review Nurse II CERIS HealthItemization Review Nurse IIFort Worth, TXRemote$61,053–$98,334 / yearPay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role.
Utilization Review Clinician - Behavioral Health Centene Corporation GroupUtilization Review Clinician - Behavioral HealthTXRemote$27.02–$48.55 / hourExperience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective.
Utilization Review Nurse Bracane CoUtilization Review NursePlano, TexasRemoteThis position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and serving as liaison between providers and medical and network management divisions. RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.
FP&A Systems Analyst AHS Staffing LLCFP&A Systems AnalystFrisco, TXRemote$90,000–$105,000 / yearThis is a highly cross-functional role that partners closely with FP&A, Accounting, and Technology teams to build and maintain the infrastructure that supports financial planning and analysis. That success is powered by a highly engaged team of talented individuals working toward one shared purpose: improving access to quality care in order to positively impact patient outcomes.