IP Facility Coder with CCS - Medical Records Presbyterian Healthcare ServicesIP Facility Coder with CCS - Medical RecordsNMThe IP Facility Coder has the knowledge and ability and will be required to code all of the following: inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services for PMG specialty providers or demonstrate coding expertise in a specific specialty deemed a critical business need by PHS Coding Leadership using the ICD-9/10 CM and CPT-4 classification system. Reviews patients entire current medical record, assigning appropriate codes including CPT, ICD and MS-DRG (as defined by UHDDS guidelines and CMS) to be used for financial reimbursement, research in accordance with Federal Regulations and Hospital and Departmental policies.
IP Facility Coder with CCS - Medical Records Presbyterian System ServicesIP Facility Coder with CCS - Medical RecordsNew MexicoThe IP Facility Coder has the knowledge and ability and will be required to code all of the following: inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services for PMG specialty providers or demonstrate coding expertise in a specific specialty deemed a critical business need by PHS Coding Leadership using the ICD-9/10 CM and CPT-4 classification system. Reviews patients entire current medical record, assigning appropriate codes including CPT, ICD and MS-DRG (as defined by UHDDS guidelines and CMS) to be used for financial reimbursement, research in accordance with Federal Regulations and Hospital and Departmental policies.
Medical Review Nurse -UM/Post Appeals (Michigan RN license req) Molina Healthcare IncMedical Review Nurse -UM/Post Appeals (Michigan RN license req)Roswell, NMREQUIRED QUALIFICATIONS: At least 2 years clinical nursing experience, including at least 1 year of utilization review (prospective, retrospective and concurrent clinical review), medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers.
Medical Review Officer (MRO) - Bid MaximusMedical Review Officer (MRO) - BidAlbuquerque, NMFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. - After completing all research, the physician must write a case rationale in the correct format that introduces the question at hand, summarizes the correct guideline, analyses the pertinent case details related to the guideline, and then make a final determination as to the medical necessity of the requested service.
Orthopedic Surgeon Telecommute Medical Review Stream Physician Concentra Inc.Orthopedic Surgeon Telecommute Medical Review Stream PhysicianAlbuquerque, NMMust be in active medical practice to perform appeals JOB-RELATED EXPERIENCE:Post-graduate experience in direct patient careJOB-RELATED SKILLS/COMPETENCIES: -Demonstrated computer skills, telephonic skills-Demonstrated ability to perform review services.-Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals. -Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer.
NewSpine Telecommute Medical Review Stream Physician ConcentraSpine Telecommute Medical Review Stream PhysicianAlbuquerque, New MexicoCurrent, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer reviewed literature that support sound and objective decision making and rationales in reviews.
NewPhysical Medicine & Rehabilitation Telecommute Medical Review Stream Physician ConcentraPhysical Medicine & Rehabilitation Telecommute Medical Review Stream PhysicianAlbuquerque, New MexicoCurrent, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer reviewed literature that support sound and objective decision making and rationales in reviews.
Medical Records Technician (Coder) US Department of Health and Human ServicesMedical Records Technician (Coder)NM$50,460–$72,644 / yearRequired as applicable for the purposes of specific eligibility and appointment claim(s), and position requirements: Indian Preference Applicants: If claiming Indian preference, applicants must provide a completed copy of the Form BIA-4432, "Verification of Indian Preference for Employment in the BIA and IHS Only." Refer to BIA-4432 link: Verification of Indian Preference for Employment in the BIA and IHS When an Indian Preference candidate possesses Veterans preference the rules regarding Veterans preference apply under ESEP and the applicant must provide documentation in order to receive preference.
Medical Records Technician US Department of Health and Human ServicesMedical Records TechnicianTohatchi, NMMENU Sign in My jobs Profile Resumes & documents Search preferences Notifications Sign out My jobs Profile Resumes & documents Notifications Search preferences Sign out Events Help Center Search Back to results Apply Medical Records Technician Department of Health and Human Services Indian Health Service Various locations across the Agency Apply Print Share Save. Perform a variety of medical records technician duties which include the complete and accurate process and maintenance of hybrid paper-electronic environment of analyzing filing compiling scanning releasing information retrieving and dispatching charts and documents file managing archiving Third Party and entering data of treatment provided to patients within a complex health care facility.
Clinical Quality Review Team Lead TriWest Healthcare AllianceClinical Quality Review Team LeadAlbuquerque, NMRemoteFull timeThe team lead supports clinical and non-clinical staff supporting CQM programs by providing training and onboarding of new staff; determining work assignments; performing audits for clinical records and/or work accuracy; and ensuring effective, consistent and accurate workflow. Technical Skills: Comprehensive knowledge of research methodology; proficient applying appropriate data analysis processes; knowledge of managed care principles and methods; knowledge in the application of clinical criteria; proficient with Microsoft Word, Excel, and PowerPoint.
CEC Records and Document Specialist/ Woodward, (1386) TriCore Reference LaboratoriesCEC Records and Document Specialist/ Woodward, (1386)Albuquerque, NM3. Receive and maintain Unlisted Report from IT, by investigating and researching Client ID and Provider Information and investigating current Client Information such as phone number, mailing address, fax number and other communication as needed, provide information to Sales Support as needed. JOB SUMMARY: Communicates with customers, including patients, physicians, clients, providers, and internal customers and provides accurate and timely resolution.
Lead Reviewing Physician Consultant (Bid) MaximusLead Reviewing Physician Consultant (Bid)Albuquerque, NMFull timeAfter completing all research, the physician must write a case rationale in the correct format that introduces the question at hand, summarizes the correct guideline, analyses the pertinent case details related to the guideline, and then make a final determination as to the medical necessity of the requested service. Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Mental Health Reviewing Consultant (Bid) MaximusMental Health Reviewing Consultant (Bid)Las Cruces, NMFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. - After completing all research, the physician must write a case rationale in the correct format that introduces the question at hand, summarizes the correct guideline, analyses the pertinent case details related to the guideline, and then make a final determination as to the medical necessity of the requested service.
Alternate Vision Reviewing Physician Consultant (BID) MaximusAlternate Vision Reviewing Physician Consultant (BID)Albuquerque, NMFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. - Maintain working knowledge of Office of Personnel Management (OPM) medical and suitability policies and ensure all consultations reflect current clinical best practices, regulatory requirements, and program objectives.
NewRemote Medical Assistant FEFA, LLCRemote Medical AssistantLas Cruces, NMRemote$15–$18 / hourp>- CMA strongly preferred - or MA/LPN/HIT/EMT training, military Medic/Corpsman background, or completed coursework in Anatomy and Physiology, Medical Terminology, Human Body Systems, and Common Diseases. This 3-month remote role puts your clinical knowledge to use reviewing documentation for Veterans' disability claims - no direct patient care, no nights, no weekends, no holidays.
Medical Scribe CVS Health CorpMedical ScribeAlbuquerque, NM$17–$28.46 / hourScribes receive extensive on-the-job training in clinical workflows, value-based medicine, preventative care for chronic conditions, accurate and specific documentation, population health data streams, and team based care. This is an excellent opportunity for pre-med track individuals looking to gain practical, paid experience in a clinical setting before applying to an MD/DO/PA/NP program, as well as those pursuing careers in Health Informatics, Public Health, Healthcare Administration, Medical Coding, and other related fields.
Behavioral Health Medical Director - AI Policy & Governance CVS Health CorpBehavioral Health Medical Director - AI Policy & GovernanceNM$174,070–$374,920 / yearRole summary: The Behavioral Health (BH) Medical Director (MD) for AI Policy & Governance provides clinical leadership to ensure artificial intelligence (AI)including predictive models and generative AIis designed, validated, implemented, and monitored in ways that are clinically sound, ethical, safe, compliant, and equitable. -Ensure equitable performance across populations (e.g., depending on how model was trained, training data may not always be representative), identify and mitigate algorithmic bias in care decisions; align AI deployment with organizational values and patient trust.
Chronic Care Management RN El Centro Family HealthChronic Care Management RNLas Vegas, NMFull timePerform comprehensive nursing assessments to develop individualized electronic care plans while monitoring chronic disease indicators, treatment adherence, and facilitating seamless transitions of care through post-hospital follow-ups and specialty referrals. This role focuses on proactive care coordination, chronic disease education, patient outreach, and interdisciplinary collaboration to improve patient outcomes, support value-based care initiatives, and ensure compliance with CMS Chronic Care Management requirements.
Chronic Care Management Registered Nurse El Centro Family HealthChronic Care Management Registered NurseEspañola, NMFull timePerform comprehensive nursing assessments to develop individualized electronic care plans while monitoring chronic disease indicators, treatment adherence, and facilitating seamless transitions of care through post-hospital follow-ups and specialty referrals. This role focuses on proactive care coordination, chronic disease education, patient outreach, and interdisciplinary collaboration to improve patient outcomes, support value-based care initiatives, and ensure compliance with CMS Chronic Care Management requirements.
Value Based Clinical Quality Coordinator El Centro Family HealthValue Based Clinical Quality CoordinatorEspañola, NMAssociate Degree in Nursing (ADN) with an active RN license in New Mexico or a compact state; alternatively, a Licensed Practical Nurse (LPN) with 5+ years of HEDIS/Star program experience may be considered. The Value-Based Clinical Quality Coordinator is responsible for promoting consistency, streamlining processes, and sharing best practices across assigned provider groups to achieve a minimum 4-star quality performance.
Chronic Care Management RN EL CENTRO FAMILY HEALTHChronic Care Management RNNMPerform comprehensive nursing assessments to develop individualized electronic care plans while monitoring chronic disease indicators, treatment adherence, and facilitating seamless transitions of care through post-hospital follow-ups and specialty referrals. This role focuses on proactive care coordination, chronic disease education, patient outreach, and interdisciplinary collaboration to improve patient outcomes, support value-based care initiatives, and ensure compliance with CMS Chronic Care Management requirements.
RN - Sr. Clinical Case Manager UnitedHealth Group IncRN - Sr. Clinical Case ManagerAlbuquerque, NM$72,800–$130,000 / yearThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. Conducts clinical evaluation of members per regulated timelines, determining who may qualify for complex case management based on clinical judgment, changes in member"s health, social determinants, and gaps in care.