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A company is looking for a Registered Nurse Coding Auditor - HCS-D, COS-C - Full Time.Key ResponsibilitiesValidates Acute Inpatient coded charts for accurate diagnostic information and complianceConducts coding audits and reviews...

A company is looking for an RN Medical Management Services.Key ResponsibilitiesManage health plan consumer/beneficiaries across the healthcare continuum to achieve optimal outcomesProvide pre-service determinations, concurrent review, and case...

A company is looking for a Senior Care Manager (RN) to assess, plan, and implement complex care management activities for members.Key ResponsibilitiesDevelops and continuously assesses care plans/service plans, collaborating with providers to...

A company is looking for a Complex Discharge Planner (RN).Key ResponsibilitiesDevelops and coordinates complex discharge plans for high-risk members based on needs assessmentsInteracts with providers and community agencies to ensure safe and...

A company is looking for a Clinical Audit Specialist - Utilization Management.Key ResponsibilitiesConduct retrospective and targeted audits of medical necessity determinationsAnalyze audit findings to identify trends and systemic issues in...

A company is looking for a Registered Nurse Senior Director Academic Practice Partnership.Key ResponsibilitiesLead the strategic design of academic partnerships to develop a sustainable nursing workforceCultivate relationships with universities...

A company is looking for an RN Educator, Clinical Documentation Integrity who must reside in Colorado.Key ResponsibilitiesFacilitate improvement in the quality and accuracy of medical record documentation through education and trainingDevelop and...

A company is looking for a Utilization Management Director - RN Required - Remote.Key ResponsibilitiesOversee day-to-day operations of the Utilization Management Department to ensure compliance with payer requirements and regulatory...

A company is looking for a Clinical Reviewer, Inpatient RN.Key ResponsibilitiesProvide utilization management activities for members in an inpatient settingDetermine medical necessity and reimbursement methodology for inpatient admissions and...

A company is looking for a Clinical Review Nurse - Correspondence.Key ResponsibilitiesDrafts correspondence letters based on clinical review outcomes in accordance with NCQA standardsInvestigates denials and provides supplemental information to...