Registered Nurse - Case Manager/Utilization Review - Part Time Days Williamson HealthRegistered Nurse - Case Manager/Utilization Review - Part Time DaysMurfreesboro, TNThe flagship facility, Williamson Medical Center, which recently opened its new Boyer-Bryan West Tower, offers extensive women's services, state-of-the-art cardiology services, advanced surgical technologies, an award-winning obstetrics and NICU, leading-edge orthopaedics, outpatient imaging services, and distinct comprehensive emergency and inpatient services for both adult and pediatric patients. Timely reviews patients within 24 hours or next business day after admission and at a minimum of every 2 days thereafter for continued stay, applying appropriate criteria (Interqual®) and facilitating reimbursement for services with third payer parties, obtaining and entering authorization number/approval status and notes in Meditech.
Clinical Documentation Integrity (CDI) Medical Records Technician HYRE HARPER Co.Clinical Documentation Integrity (CDI) Medical Records TechnicianMemphis, TennesseeAs a Medical Records Technician (MRT) specializing in Clinical Documentation Integrity, you will collaborate with healthcare providers, coding professionals, and clinical staff to ensure that medical records accurately reflect the patient’s clinical status, diagnoses, and treatment plans. Certifications: Must hold current certification from one or more of the following: ACDIS (Association of Clinical Documentation Integrity Specialists): Certified Clinical Documentation Specialist (CCDS)) .
NewMedical Records Clerk (2nd shift) Elevance HealthMedical Records Clerk (2nd shift)Nashville, TennesseeWe are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy.
NewMEDICAL REVIEW SPECIALIST - 07072026- 78963 State of TennesseeMEDICAL REVIEW SPECIALIST - 07072026- 78963Nashville, TNServes as resource person providing technical and educational assistance and consultation to internal and external groups regarding policy, protocol, best practices, interpretation of data, and other related information to prevent the spread of communicable diseases, spread preparedness for emergency situations, and promote the safety and well-being of others. This class differs from that of Public Health Nursing Con 2 in that an incumbent of the latter may directly supervise a staff of professional and sub-professional personnel including employees of this class or have oversight over a moderate to large statewide program.
Medical Record Specialist Erlanger Behavioral HealthMedical Record SpecialistChattanooga, TennesseeFull timePull charts as requested for audits, peer review, readmissions, HBIPS processing and route to appropriate area or department. Assist with Maintaining medical record integrity through filing, assembling, analysis and retrieving confidential patient records.
NewSenior Medical Records Analyst (2nd Shift: 1:30p-10p; 2:30p-11p) - HYBRID Vanderbilt University Medical CenterSenior Medical Records Analyst (2nd Shift: 1:30p-10p; 2:30p-11p) - HYBRIDNashville, TennesseeDiscover Vanderbilt University Medical Center : Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. Breadth of Knowledge: Applies broad job knowledge and has basic job skills in other areas.* Team Interaction: Provides informal guidance and support to less experienced team members.
Senior Medical Records Analyst - HYBRID Vanderbilt University Medical CenterSenior Medical Records Analyst - HYBRIDNashville, TNDiscover Vanderbilt University Medical Center: Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. Breadth of Knowledge: Applies broad job knowledge and has basic job skills in other areas.* Team Interaction: Provides informal guidance and support to less experienced team members.
ROI Medical Records Specialist MRO CorporationROI Medical Records SpecialistMaryville, Tennessee$16–$22 / hourFull timeResponsibilities: Determines records to be released by reviewing requestor information in accordance with HIPAA guidelines and obtaining pertinent patient data from various sources, including electronic, off-site, or physical records that match patient request. Overview: The ROI Specialist is responsible for providing support at a specified client site for the Release of Information (ROI) requests for patient medical record requests*.
Medical Records Specialist HCA HealthcareMedical Records SpecialistNashville, TNAs a Medical Records Specialist, you would be responsible for assisting the HIM Director by routinely performing duties in support of the management of the Horizon Patient Folder (HPF)/McKesson Patient Folder (MPF) workflow queues, working applicable worklists within 3M 360 Encompass, the resolution of unbilled accounts, and the processing of physician suspensions. Completes any certification program and continuing education that may be required by state law to accurately perform the duties of the birth certificate clerk completion and works under the guidelines and process as defined by the state.
Medical Records Specialist Part Time Weekdays HCA Healthcare IncMedical Records Specialist Part Time WeekdaysHendersonville, TNJob Summary and Qualifications As a Medical Records Specialist, you would be responsible for assisting the HIM Director by routinely performing duties in support of the management of the Horizon Patient Folder (HPF)/McKesson Patient Folder (MPF) workflow queues, working applicable worklists within 3M 360 Encompass, the resolution of unbilled accounts, and the processing of physician suspensions. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing.
Medical Review Officer (MRO) - Bid MaximusMedical Review Officer (MRO) - BidNashville, TNFull 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.
NewCoding and Medical Records Auditor American Health Companies IncCoding and Medical Records AuditorFranklin, TNAssist with validation audits to evaluate medical record documentation to ensure coding accurately reflects and supports relevant coding based on the ICD-10 code submitted to CMS and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions applicable to Medicare Risk Adjustment reimbursement initiatives. Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries as needed to verify and ensure the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered.
Medical Records Director-LPN STONERIVERMedical Records Director-LPNMurfreesboro, TNFull timeThis role ensures timely documentation, supports clinical and administrative staff, and maintains confidentiality and integrity of all medical information within the skilled nursing facility. General PurposeThe Medical Records Director oversees the management, security, and accuracy of resident health records in compliance with federal, state, and facility regulations.
Medical Record Specialist Acadia Healthcare Co IncMedical Record SpecialistChattanooga, TNPull charts as requested for audits, peer review, readmissions, HBIPS processing and route to appropriate area or department. PURPOSE STATEMENT: Assist with Maintaining medical record integrity through filing, assembling, analysis and retrieving confidential patient records.
Medical Records Assistant (Non Nurse) Life Care Centers of America IncMedical Records Assistant (Non Nurse)Louisville, TNAccurately audit and complete ongoing reviews of all patients' clinical records to ensure documentation and performance compliance. Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours.
NewMedical Records Assistant (Non Nurse) Life Care Center of TullahomaMedical Records Assistant (Non Nurse)Tullahoma, TennesseeAccurately audit and complete ongoing reviews of all patients’ clinical records to ensure documentation and performance compliance. Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours.
Medical Records Technician (PRN) Customer Value PartnersMedical Records Technician (PRN)Memphis, TennesseePart timeCurrent certification from American Health Information Management Association (AHIMA) and/or American Academy of Professional Coders (AAPC) and/or Association of Clinical Documentation Integrity Specialists (ACDIS). CVP is an award-winning healthcare and next-gen technology and consulting services firm solving critical problems for healthcare, national security, and public sector clients.
Medical Records Clerk University of Tennessee Medical CenterMedical Records ClerkKnoxville, TNPosition Qualification: High School diploma or GED; or one to three months related experience and/or training; or equivalent combination of education and experience. Assists with any special projects as requested by Medical Record Department Management Team.
Clinical Quality Review Team Lead TriWest Healthcare AllianceClinical Quality Review Team LeadNashville, TNRemoteFull 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.
Lead Reviewing Physician Consultant (Bid) MaximusLead Reviewing Physician Consultant (Bid)Nashville, TNFull 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.
Utilization Review Director - Addiction Recovery Summit Behavioral Healthcare LLCUtilization Review Director - Addiction RecoveryTNAbility to communicate professionally and effectively with multidisciplinary team members, managed care organizations and business office, providing needed information in a logical, concise manner using technical language that accurately describes client's condition. About the Job: PURPOSE STATEMENT: The Director of Utilization Management is responsible for the overall management of the UM department by leading and facilitating review of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria.
Mental Health Reviewing Consultant (Bid) MaximusMental Health Reviewing Consultant (Bid)Nashville, TNFull 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)Memphis, TNFull 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.
HH Clinical Record Auditor BrightSpring Health ServicesHH Clinical Record AuditorNashville, TNThe Clinical Record Auditor is a clinician that conducts a comprehensive assessment of home health clinical records to ensure clinical documentation requirements are met, that it is clear, reflects the care provided, the patient's response to care, meets regulatory and company requirements, reflects patient eligibility, and supports billing requirements. Through the Company's service lines, including pharmacy, home health care, and rehabilitation, we provide comprehensive and more integrated care and clinical solutions in all 50 states to over 475,000 customers, clients and patients daily.
PreVisit Planning Coder - Summit Medical Group Summit Medical GroupPreVisit Planning Coder - Summit Medical GroupKnoxville, TNWith use of specified reports, HCC database, Athena EHR, hospital portals, member summaries and Group Management, review all records, progress notes and diagnosis for accuracy and completeness of documentation to support ICD coding to the highest level of specificity. Continuous use and awareness of ethical coding, the official coding rules, regulations, and coding conventions of the American Hospital Association (Coding Clinic), ICD-9/ICD-10-CM, Centers for Medicare, and Medicaid Services (CMS), and organizational/institutional coding guidelines.
PreVisit Planning Coder - Summit Medical Group SUMMIT MEDICAL GROUP OPERATIONS LLCPreVisit Planning Coder - Summit Medical GroupKnoxville, TNPart timeWith use of specified reports, HCC database, Athena EHR, hospital portals, member summaries and Group Management, review all records, progress notes and diagnosis for accuracy and completeness of documentation to support ICD coding to the highest level of specificity. Continuous use and awareness of ethical coding, the official coding rules, regulations, and coding conventions of the American Hospital Association (Coding Clinic), ICD-9/ICD-10-CM, Centers for Medicare, and Medicaid Services (CMS), and organizational/institutional coding guidelines.
Orthopedic Spine Surgeon - Medical Reviewer (TN) Dane StreetOrthopedic Spine Surgeon - Medical Reviewer (TN)TNRemoteIn this role, you will apply your clinical expertise to conduct comprehensive medical record reviews and provide objective, evidence-based opinions on cases involving spinal conditions, injuries, treatments, and surgical interventions. Dane Street is seeking experienced Board-Certified Orthopedic Spine Surgeons licensed in Tennessee to join our growing panel of independent physician reviewers.
Network Medical Director - (Field-based /Remote) UnitedHealth Group IncNetwork Medical Director - (Field-based /Remote)Nashville, TNRemote$248,500–$373,000 / 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. Collaborates in teaching clinicians and clinical operations teams about Medicare Risk Adjustment, CMS STARs/HEDIS, and overall population health approach to patient care in both formal presentations and off the cuff at impromptu opportunities.
Medical Management Clinician Senior Elevance Health IncMedical Management Clinician SeniorNashville, TNConducts and may approve pre-certification, concurrent, retrospective, out of network and/or appropriateness of treatment setting reviews by utilizing appropriate medical policies and clinical guidelines in compliance with department guidelines and consistent with the members eligibility, benefits and contract. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
Medical Scribe (Center Float) CVS Health CorpMedical Scribe (Center Float)Knoxville, TN$17–$25.65 / hourResponsibilities: Documenting Patient Encounters ~ 80% • Joining the provider in the exam room to observe patient visits • Documenting patient encounters in a structured note, including the history of the present illness, assessment, plan, and physical exam • Assigning appropriate CPT and ICD-10 codes • Preparing After Visit Summaries • Consulting with provider to ensure accurate and specific documentation • Clinical Documentation Improvement ~ 10% • Requesting and reviewing medical records • Leveraging Oak Streets population health tools to support clinical documentation improvement • Preparing for and supporting Daily Huddles and Clinical Documentation Reviews • Consulting with provider on clinical documentation opportunities • Administrative support for your provider and care team ~ 10% • Placing orders and referrals • Addressing tasks • Supporting the care team with additional responsibilities related to clinical documentation Other duties as assigned. What we're looking for: Knowledge: • Knowledge of medical terminology and common medications, either from a pre-medical degree or prior clinical experience [required] • Prior clinical experience, including shadowing and/or volunteering [strongly preferred] • Prior scribe or transcription experience [preferred but not required].
Medical Authorization Specialist Bioventus IncMedical Authorization SpecialistMemphis, TNEducation and Experience: High school diploma plus 4 years of related experience or 4-year college degree 1 year medical authorization experience involving medical record review required Knowledge and interpretation of medical terminology and ICD-10 coding Must possess good written and oral communication skills with the ability to interface with customers and company personnel at all levels. Strong persuasion/negotiation skills Must display professional persistence, manage detailed information; maintain high level of organization; display strong proficiency in multi-tasking by effectively managing time and priorities PC experience in Microsoft Word, Excel, Outlook or other related software required Knowledge of SAP or other integrated software applications preferred.
NewManager Clinical Performance & Quality (Nurse Practitioner/Physician Assistant) Elevance Health IncManager Clinical Performance & Quality (Nurse Practitioner/Physician Assistant)Nashville, TNDevelop and manage clinical quality reviews to ensure peer review and clinical quality chart audit process including targeting chart reviews, auditing percentages, score guidelines feedback mechanism and ensure compliance with remediation procedures. Requires a master's in Nursing (or PA equivalent) and at least 3 years of clinical experience in applying appropriate diagnosis in the Medicare HCC Mode; or any combination of education and experience, which would provide an equivalent background.
Director of Risk Management and Revenue Integrity American Health PlansDirector of Risk Management and Revenue IntegrityFranklin, TNFull timeThis role acts as the risk adjustment program subject matter expert and works closely with other areas of health plan operations and programs, ensuring risk adjustment data operations are administered accurately, timely and in compliance with CMS regulations. • Enjoy engaging in the outlining of program development and management processes, manages the overall scoping, planning, business requirements gathering and delivery of risk adjustment program activities from idea inception to ongoing support and enhancement.
Nurse Practitioner, Remote, Telehealth, weekends ChenMed LLCNurse Practitioner, Remote, Telehealth, weekendsMemphis, TNRemote$111,140–$158,771 / yearProficient skill in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook; competent in keyboarding and other systems required for the position. EDUCATION AND EXPERIENCE CRITERIA: Bachelor's degree in Nursing (BSN) and graduate of a school of nursing for Advanced Practice Nursing with certification in area of specialty required.