4239 case reviewer jobs found

Responsibilities:The Clinical Appeals Reviewer reports to the Supervisor Appeals and Grievances and is responsible for processing appeals and grievances ensuring all milestones are within compliance.* Outreaches to the appellant or their representative and is responsible for obtaining and reviewing medical records and packaging all pertinent information into a case for a determination.* Directly interacts with providers to obtain additional clinical information as well as with members or their advocates to understand the full intent of the appeal or grievance.* Throughout the performance of their duties, the Clinical Appeals Reviewer provide clinical expertise and may make determination of medical necessity for case classifications when necessary and provides a front-line regulatory/compliance function in their evaluation of appeals and grievances.* Receives an appeal or grievance case, prior to assigning to the Coordinator Appeals and Grievances. so that Coordinator Appeals and...

Work Status Details: Full Time | 72.00 Hours Every Two Weeks Exempt from Overtime: Non-Exempt Shift Details: Evenings/Nights Rotation Department: St Joseph's Nursing | Reports To: Director of Nursing-Nursing Home The mission of Faith Regional Health Services is to serve Christ by providing all people with exemplary medical services in an environment of love and care. Summary: Under the direction of the registered nurse (RN), provides nursing care in accordance with departmental and facility policies and procedures as well as with their State Practice Act. The licensed practical nurse (LPN) assists the RN with assessing, planning, implementing, and evaluating resident care. The LPN is responsible for documentation of their care including interventions, outcomes, and resident/family education. They collaborate with physicians and other members of the interdisciplinary health care team to provide continuity of care. The LPN is responsible for the direction and assignment of nursing...

Quality Assurance Analyst 100% Remote 6-12 month contract The Quality Assurance Analyst will be responsible for working closely with internal product owners and business users to understand requirements, translate those into test cases, execute those test cases, and track progress and defects for testing. Minimum Skills required: Experience in quality assurance testing of new and existing software and passionate about quality. Strong written & verbal communication skills. Ability to focus on details and document and troubleshoot errors. Strong organizational skills which will be used to appropriately document test plans and test cases, organize and run meetings, and participate in testing. Proactive thinking and behavior: being able to anticipate, plan and execute in ways which help drive and increase the efficiency of our business. Ability to collaborate and work effectively with leaders and team members Ability to work with minimal supervision,...

Locations: VA - Richmond, United States of America, Richmond, Virginia Lead Data Engineer Do you love building and pioneering in the technology space? Do you enjoy solving complex business problems in a fast-paced, collaborative, inclusive, and iterative delivery environment? At Capital One, you'll be part of a big group of makers, breakers, doers and disruptors, who solve real problems and meet real customer needs. We are seeking Data Engineers who are passionate about marrying data with emerging technologies. As a Capital One Lead Data Engineer, you ll have the opportunity to be on the forefront of driving a major transformation within Capital One. What You ll Do: Collaborate with and across Agile teams to design, develop, test, implement, and support technical solutions in full-stack development tools and technologies Work with a team of developers with deep experience in machine learning, distributed microservices, and full stack systems...

Responsibilities Specific to Position + Establish and utilize the plan of care to implement and direct patient care (the plan of care is updated at least monthly and also as changes occur); progress notes should reflect utilization of the care plan + Recognize the patient and family as the unit of care + Inform the patient's insurance case manager via the Managed Care Liaison about the ordered visit frequency plan(s) for patient care and patient's status + Provide clinical supervision of the hospice home care team + Home Health Aide (HHA) care plans must be reviewed and/or updated with each onsite visit and initialed; the original is kept on the chart and staff are responsible for weekly updates + Perform HHA onsite supervisory visits every 14 days according to Medicare guidelines, and conduct an onsite with the HHA during the first week after start of care + Performs all aspects of the skilled nurse home visit: + Plan and prepare for the visit + Perform skilled...

**Nurse Medical Mgmt I**+ Job Family: Medical and Clinical+ Type: Full time+ Date Posted:Jan 25, 2023+ Req #: JR49649**Location:**+ CA, Woodland Hills+ California, California**Description****Location: Remote (Work from Home)****Must reside in CA**Responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards accurately interpreting benefits and managed care products and steering members to appropriate providers, programs or community resources. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also...

Mainframe Network Systems ProgrammerRemote - United StatesJR008739**Key Areas of Focus for this Role**+ Responsible for IT mainframe Network systems programming and general product support including configuring interfaces to other subsystems.+ Plans, coordinates, installs, configures, tests, administers, maintains, updates, implements, tracks changes and/or provides corrective maintenance to mainframe Network-related software.+ Diagnoses, resolves, and documents mainframe Network-related problems.+ Adheres to ITIL, Change and Problem Management process.+ Effectively communicates with software suppliers, peers, clients and Leadership.+ Maintains current software and products by ensuring system availability and performance in accordance with service agreements.+ Monitors and reports on system/product performance, reliability and consistency.+ Increases efficiency through automation and/or template utilization as appropriate.+ Review and seek out cost reductions, efficiency...

"They require Postgres DB as mandatory skill with Java Anuglar JS skills.. J2EE , Angular JS , Progress Database , React "CWR okRate : $70 per hr or $110,000 Role (Choose from dropdown)Sr. DeveloperSkill FamilyJavaTechnical skill requiredJ2EE , Angular JS , Progress Database , ReactTechnical skill desiredCore Java , JDBC , ANSI SQL , Jira , AgileDetailed Job Description:Profile Needed for Full stack developer Desired Skills - Java,J2EE,Angular, React JS and Progress DB Additional Skills - Agile,JIRA Analysis & Design: - Study assigned functional specifications analyze and identify impact of specifications raise queries and seek resolution from different stakeholders - Provide required support to develop the proof of concept. Coding: - Develop coding as required in the project - Raise clarifications issues concerns regarding work output to the lead on time seek review from peer Senior Developer periodically - Highlight any potential risks to the Leads and seek inputs to resolve...

Company DescriptionPerformance Foodservice, PFG's broadline distributor, maintains a unique relationship with a variety of local customers, including independent restaurants and hotels, healthcare facilities, schools, and quick-service eateries. A team of sales reps, chefs, consultants and other experts builds close relationships with each customer, providing advice on improving operations, menu development, product selection and operational strategies. The Performance Foodservice team delivers delicious food, but also goes above and beyond to help independent restaurant owners achieve their dreams.Job DescriptionPosition Summary:The Shuttle Driver is responsible for driving tandem trailers, tractor trailers and/ or straight trucks on intrastate and interstate routes for the purpose of transporting empty trailers to PFG warehouse locations to turn around and deliver full trailers with various food products (meats, produce, frozen foods, groceries, and dry goods) to domicile/shuttle...

Tryfacta is hiring a Registered Nurse, Cardiac Cath Lab. Are you ready to join an experienced team? For over 25 years, Tryfacta has provided workforce services and solutions for Healthcare, Admin, and Information Technologies. We are looking for a Registered Nurse to work at a specialty care center in San Jose, CA. Registered Nurse Responsibilities and Duties: The Registered Nurse assists cardiologists during the entire catheterization process. The Registered Nurse prepares patients before and after the procedure to stabilize their health status. The Registered Nures reviews patient documents, maintains and operates facility equipment, monitors patient health status and schedules appointments to follow the health plan. Registered Nurse Required Experience: One year of experience as a Cardiac Cath Lab RN One year of experience in critical care Registered Nurse Requirements: BLS ACLS Moderate Sedation CA RN license EPIC experience preferred Good communication skills ***Note:...

MAXIMUS IS CURRENTLY HIRING FOR A REMOTE-CLINICAL QUALITY ASSURANCE MANAGER (NP)! THIS POSITION REQUIRES A NURSE PRACTITIONER LICENSE IN THE STATE OF NEW YORK. The Clinical QA Manager leads an efficient and effective clinical quality assurance program that identifies opportunities for improvement and develops quality improvement initiatives to deliver and ensure ongoing quality assurance throughout the IPP project. This position works collaboratively with program leadership and colleagues to ensure alignment with program objectives and share and adopt best practices across programs. A team of Quality Assurance staff report to this position. The Clinical QA Manager ensures that team of Quality Assurance staff are equipped with the training and expertise to support the IPP program. ESSENTIAL DUTIES AND RESPONSIBILITIES: Manages an effective quality assurance program that monitors and proactively identifies and resolves issues Manages Quality Assurance staff inclusive of...

At JPMorgan Chase, we have an obsession for taking care of our customers and employees and making them feel welcomed and valued by building lasting relationships, doing the right thing, exceeding expectations and having a strong commitment to diversity and inclusion. Using the latest banking solutions combined with cutting edge financial technology and the most welcoming and friendly service, you'll be front and center representing our brand and culture. Here at Chase, you'll have the opportunity to help people experience our Customer Promise -- helping people make the most of their money so they can make the most of their lives, by providing education and advice tailored to suit their financial needs.You have a proven record for delivering outstanding service to clients. You've successfully collaborated with colleagues and worked as part of a team to achieve business results. You have established relationships within a company to deliver for clients. Apply these talents as a...

Summary This is an open continuous announcement until September 29, 2023. Qualified Applicants will be considered and referred as vacancies become available. All applicants may receive consideration for 3 months from the date of application. If you wish to be considered after that period, and the announcement is still open to receive applications, you must re-apply to indicate your continued interest. Responsibilities VA offers a comprehensive total rewards package: VA Nurse Total Rewards The Critical Care Staff RN must be proficient in the care of adult patients with critical nursing care requirements including telemetry monitoring and keeping them hemodynamically stable. This includes but is not limited to continuous cardiac monitoring, assisting in the insertion of invasive lines such as arterial lines, Swan-Ganz catheters and maintenance, hemodynamic monitoring, multiple vasoactive drips, mechanical ventilation, EKG/rhythm strip interpretation, moderate sedation, post-surgical...

Description Position at DHR Health The RN Cardiovascular Abstractor position has the capability of converting to a hybrid position. POSITION SUMMARY: Responsible for assisting the medical and hospital patient care staff in ensuring quality patient care and compliance with Texas law, CMS and The Joint Commission requirements through quality program design, and data collection, analysis and presentation. POSITION EDUCATION/ QUALIFICATIONS : Bachelor's Degree in Nursing Preferred Texas Registered Nurse (R.N.) license requiredMinimum of five ( 5 ) years of hospital experience in a progressively responsible position requiring contact with various departments - Cardiac experience preferredAbility to read, write, and speak English JOB KNOWLEDGE/EXPERIENCE : Ability to communicate clearly and concisely with all levels of nursing, administration, and physiciansDemonstrated leadership experienceRegistry / Core Measures abstraction experience preferredMust have the attitude that building the...

We believe in the power and joy of learning At Cengage Group, our employees have a direct impact in helping students around the world discover the power and joy of learning. We are bonded by our shared purpose driving innovation that helps millions of learners improve their lives and achieve their dreams through education. Our culture values diversity, engagement, and discovery Our business is driven by our strong culture, and we know that creating an inclusive and diverse workplace is absolutely essential to the success of our company and our learners, as well as our individual well-being. We recognize the value of diverse perspectives in everything we do, and strive to ensure employees of all levels and backgrounds feel empowered to voice their ideas and bring their authentic selves to work. We achieve these priorities through inclusive programs, benefits, and initiatives that are integrated into the fabric of how we work every day. To learn more, please see . Responsibilities :...

Physician Extender (PA/NP) SITE OF SERVICE : + Minot Air Force Base Family Practice + Full Time POSITION QUALIFICATION/REQUIREMENTS: + Degree: + Nurse Practitioner Master s Degree in nursing + Physician Assistant Bachelor s Degree + Education: + Nurse Practitioner: Graduate from an academic program, within the nursing specialty field of study that is accredited by a regional or national nursing accrediting agency recognized by the Accreditation Commission for Education in Nursing (ACEN) OR the Commission on Collegiate Nursing Education (CCNE). + Physician Assistant: Graduate from an accredited college or university certified by the Accreditation review Commission on Education of the Physician Assistant (ARCPA). + Certification: + Nurse Practitioner: Certified as a Nurse Practitioner by the American Nurses Credentialing Center (ANCC), American Academy of Nurse Practitioners (AANP) OR the recognized national nursing certification organization for the specialty area of practice as...

Are you looking for a high energy, strategic, and fast-paced position as a QA Engineer? Join Relias, the company changing lives throughout the world by helping healthcare organizations improve their clinical and financial outcomes!For 11,000+ health care and human service organizations, Relias helps clients deliver better clinical and financial outcomes by elevating the performance of teams. We help organizations across the continuum of care get better at maintaining compliance, developing staff and promoting consistent, high-quality care. Our platform employs assessments to reveal specific gaps in skills and addresses them with personalized and engaging learning, choosing from 7,000+ online courses that meet accrediting board, state and federal requirements. We are passionate about our products and our clients; what we deliver and the impact we have on the world is truly something you can be proud to represent. Join us and make a difference.WHAT CAN RELIAS OFFER YOU? Fantastic...

Description ProMedica Senior Care, formerly HCR ManorCare, provides a range of services, including skilled nursing care, assisted living, post-acute medical and rehabilitation care, hospice care, home health care and rehabilitation therapy. $5,000 Sign On Bonus, Generous Wage Scale, Student Loan Repayment Assistance & more! The Wound Nurse is a registered licensed nurse designated to act as the coordinator of the center s wound team to oversee the general application of the skin management program. The Wound Nurse is responsible to coordinate and lead weekly wound team rounds and processes, including rounds, measurements, interdisciplinary care plan review, treatment recommendations, physician orders, and required documentation. In return for your expertise, you will enjoy excellent training, industry-leading benefits and unlimited opportunities to learn and grow. Be a part of the team leading the nation in healthcare. 431 - ProMedica Skilled Nursing and...

Nursing Assistant Burlington Job ID: R57779 Shift: 1st Full/Part Time: Part_time Location: 252 McHenry St Burlington, WI 53105 Benefits Eligible: Yes Hours Per Week: 20 Schedule Details/Additional Information: Monday- Friday 8:00 AM-12:00 PM No weekends or holidays currently Provides basic, quality patient focused care in clinical setting under daily direction and supervision of Registered Nurse (RN) in accordance with the standards of practice within guidelines of corresponding state regulations. Performs delegated tasks in patient care setting that supports environment of patient care and assures patients and family are treated in a holistic manner with dignity and respect. Assists RN with daily care of patients including bathing, oral hygiene, feeding, activity orders and ambulation which may include use of therapeutic assistive devices, proper positioning, range of motion and special transferring as indicated. Measures and documents blood...

$30,000 sign-on, 4 weeks PTO, and more This Jobot Job is hosted by: Emily Ayers Are you a fit? Easy Apply now by clicking the "Apply" button and sending us your resume. Salary: $65,000 - $105,000 per year A bit about us: Do you want to work for the TOP health system in the state, and one of the best in the country? One of the top providers for specialty clinical and medical services in Pennsylvania and New Jersey, we pride ourselves on giving the highest level of care to our patients, communities, and people We have over 250 clinical practices, 2000 Physicians, and inpatient, outpatient, and acute care services, to provide a new and improved healthcare experience for all we serve. Why join us? The world of healthcare is changing, and we are evolving with it. By joining our team, you'll have access to: Stellar benefits, including Medical, Vision, Dental, Retirement, Vacation (4 weeks) Flexible Scheduling Growth, training, and opportunities to continue to grow Top compensation in the...