RN LTSS Auditor & Quality Risk Analyst
Molina Healthcare, Inc.
Molina Healthcare, Inc. is seeking an RN with LTSS/audit experience to support clinical auditing of long-term services and supports. You will review care management records, identify health and safety risks, and help ensure timely remediation while preserving member confidentiality. Responsibilities include conducting retrospective and concurrent audits, analyzing data to spot trends, reporting findings to leadership, and helping develop training materials to address audit results within a #J-18808-Ljbffr Molina Healthcare, Inc.
$29.05 - $56.64 per hour
...term services and supports (LTSS) auditing activities. Performs risk-focused audits and... ...overarching strategy to provide quality and cost-effective member... ...experience. Registered Nurse (RN). License must be active... ...CPHQ), Certified Internal Auditor (CIA), or other related...SuggestedHourly payWork experience placementWork at office$41.2 - $62.17 per hour
...Building Full time R188249 Job Description: The Revenue Integrity RN Charge/Coding Auditor is responsible for consulting on clinical charge Audits for... ...rules, regulations, hospital charging and coding, clinical quality and clinical policy guidelines necessary to guarantee...SuggestedHourly payFull timeWork at officeRemote workFlexible hours- Intermountain Health is seeking a Revenue Integrity RN Charge/Coding Auditor to audit clinical charges, review denials, and defend audits across Intermountain hospitals and clinics. The role requires RN licensure and coding certification, with strong knowledge of the revenue...SuggestedRemote job
- ...Intermountain Health is seeking a Revenue Integrity RN Charge/Coding Auditor to consult on clinical charge audits for Intermountain Health facilities. The role audits medical records for denials, defense reviews, and retrospective analyses while ensuring compliance with...SuggestedRemote work
$26.41 - $51.49 per hour
...Care Manager, LTSS (RN) - Field travel in Dane County, WI Join to apply for the Care Manager, LTSS (RN) - Field travel in Dane County... ...to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on...SuggestedHourly payFull timePart timeWork experience placementRelocation packageAll shiftsShift workDay shift- ...coordination long-term services and supports (LTSS)-specific activities. Collaborates with... ...to overarching strategy to provide quality and cost-effective member care. Essential... ...education and experience. Registered Nurse (RN). License must be active and unrestricted...Work at officeLocal areaRemote work
- Molina Healthcare is seeking a Registered Nurse Care Manager to support care management and LTSS services in Wisconsin. The role collaborates with a multidisciplinary team to coordinate member care across settings, with emphasis on high-need individuals and cost-effective...Remote job
- Molina Healthcare is hiring a registered nurse to provide care management and coordination for LTSS programs. The role collaborates with a multidisciplinary team to deliver integrated member care and achieve desired outcomes. The position requires in-person assessments...
- Molina Healthcare is seeking an RN care manager to support care coordination and LTSS activities. This remote role involves traveling within Dane County to conduct in-person assessments and collaborate with an interdisciplinary team to optimize member outcomes. The ideal...Remote job
- Quality Assurance Analyst I Location: Wisconsin | Hybrid, 1 day onsite per week in Madison Contract: Long Term, Multi-Year Start Date: Mid-November Position Overview We are seeking a Quality Assurance Analyst I to support a web application development team in a hands-on...Contract workRelocation1 day per week
- ...remarkable Join the #1 hospital in Wisconsin! We are seeking a Coding Quality Analyst to: Develop and implement an organized monitoring system for... ...(for non-HCC roles) or 3 years of experience in HCC Risk Adjustment (for HCC roles) required 3 years progressive coding...Work experience placementRemote workShift work
- Lumicera Health Services is seeking an Analyst, Pharmacy Quality to join our team. This role drives the development, implementation, and monitoring of processes to audit and report key performance indicators for pharmacy operations. The analyst collaborates with leadership...Remote job
- UW Health is seeking a Coding Quality Analyst to develop and manage a QA monitoring system for coding quality and to coordinate the review process for CPT, ICD-10-CM, and HCPCS coding across departments. The role includes identifying education opportunities, providing feedback...Remote job
- WHEDA seeks a Quality Assurance Analyst to join our Commercial Lending Department in the Madison facility. The role provides expert analytical support and quality control for multifamily affordable housing and economic development programs, ensuring compliance with federal...Local area
- Wisconsin Housing and Economic Development Authority (WHEDA) seeks a Quality Assurance Analyst for its Commercial Lending Department in Madison. The role provides expert analytical support and quality control for multifamily affordable housing and economic development programs...Work at officeLocal area
- WHEDA in Madison, WI is seeking a Quality Assurance Analyst to provide expert analytical support and quality control to the Commercial Lending Department for multifamily affordable housing and economic development programs. The role ensures strict compliance with federal...Local area
- NexRep LLC is seeking a Quality Specialist to analyze calls, emails, social media posts and SMS contacts from NexRep's independent marketplace contractors, identifying trends and working with the certification and operations teams to ensure client standards are met. You...Remote jobFor contractors
- Beacon Hill Staffing Group seeks a Quality Assurance Analyst I to support a web application team in hands-on testing. You will verify acceptance criteria, test functionality, and ensure UI consistency while collaborating with developers and business analysts. The ideal...Long term contract1 day per week
$67.02k - $82.56k
...schedule, based on position and business needs.See more details below related to this specific position. WHEDA is seeking a Quality Assurance Analyst to join our Commercial Lending Department in our Madison facility. SALARY: Hiring Range for this position is from $61,044...Full timeWork at officeLocal areaRemote workVisa sponsorshipWork visa- ...states. Approved Remote Work States ListingBe part of something remarkableJoin the #1 hospital in Wisconsin!We are seeking a Coding Quality Analyst to:Assess the accuracy and completeness of the coding of inpatient cases by performing retrospective and concurrent audits and...Remote workMonday to FridayFlexible hoursShift workWeekday work
$59.3k - $80.9k
...Become a part of our caring community The Medical Coding Auditor reviews medical claims submitted against medical records provided... ...encounter information Support and participate in process and quality improvement initiatives Use your skills to make an impact...Bi-weekly payFull timeContract workTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday$79.7k - $105.48k
...guidance and trainings on policies. Job Summary The Compliance Auditor is responsible for conducting coding, documentation audits to... ...detailed claim reviews, identifies coding and documentation risks, analyzes trends, develops recommendations for improvement, and...Full timeTemporary workLocal areaImmediate startRemote workFlexible hours$66k - $94.1k
...succeeds together. Because at UKG, your work matters—and so do you. Role Overview: We are seeking a detail-oriented Data Quality & Insights Analyst to turn business questions and operational data into clear, reliable analysis. In this role, you will partner with business...Local areaWorldwide- UKG Inc. is seeking a detail-oriented Data Quality & Insights Analyst to turn business questions and operational data into reliable analysis. In this role, you will partner with business stakeholders to gather requirements, prepare and validate data, maintain reporting...
- A leading advisory firm in Madison, Wisconsin, is seeking an experienced professional with a bachelor's degree in accounting and at least two years of audit experience. Responsibilities include providing assurance services and engaging with clients to assess financial statements...
- Datavant is seeking a CDQI Audit Specialist to evaluate CDI reviews, ensure accuracy and compliance, and identify opportunities for education and process improvements across the CDI program. You will audit CDQI specialists' work, provide feedback, collaborate with physicians...
- Emory Healthcare is seeking a Remote Medical Coding Auditor to ensure accurate, complete, and compliant professional coding documentation. The role reviews records, identifies discrepancies, and collaborates with providers and coding teams to maintain accurate coding practices...Remote job
- Humana is seeking a Medical Coding Auditor to review outpatient claims for accurate CPT/HCPCS coding and ICD-10-CM references. The role emphasizes accuracy, confidentiality, and adherence to guidelines in an outpatient setting. You will analyze documentation, perform CPT...Remote jobWork from home
- ...practices. Supports appropriate reimbursement and mitigates compliance risks through detailed coding reviews. Conducts comprehensive chart reviews to evaluate coding accuracy and documentation quality. Evaluates provider documentation to ensure appropriate coding and...Remote jobWork at office
- CVS Health seeks a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU) to ensure coding compliance. You will review medical records for CPT/HCPCS and Revenue codes, document findings, and communicate findings to ...
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