Title: Senior Clinical Admin Nurse – Remote

Location: Phoenix AZ US

Full Time

The Senior Clinical Admin Nurse will be responsible for providing inidualized attention to UMR membership and covered families and serves to assist with navigation of the health care system. The purpose of the clinical liaison nurse is to help iniduals live their lives to the fullest by supporting coordination and collaboration with multiple and external partners including consumers and their families/caregivers, medical, and other clinical teams.

Primary Responsibilities:

• • Provide members with tools and educational support needed to navigate the health care system and manage their health concerns effectively and cost efficiently

• • Assist members with adverse determinations, including the appeal process

• • Teach members how to navigate UMR internet-based wellness tools and resources

• • Outreach to membership providing pre-admission counseling to membership

• • Outreach to membership providing discharge planning to membership and caretakers

• • Track all activities and provide complete documentation to generate customer reporting

• • Accept referrals via designated processes, collaborate in evaluating available services, and coordinate necessary medical care and community referrals as needed

• • Comply with all policies, procedures and documentation standards in appropriate systems, tracking mechanisms and databases

• • Contribute to treatment plan discussions

• • Other duties as assigned

Candidate must be willing to work Monday – Friday 8:00 am – 5:00 pm

Required Qualifications:

• • Current and unrestricted RN compact license

• • 2+ years of acute nursing experience

• • Basic computer proficiency (ie MS Word, Outlook)

• Proven ability to function independently and responsibly with minimal supervision

Preferred Qualifications:

• • Bachelor’s degree in nursing

• • CCM

• • 2+ years managed care experience

• • Critical care, pediatric, med-surg and/or telemetry experience

• • Utilization management experience

• • Adverse Determination experience

• • Telecommute experience

Soft Skills:

• • Demonstrated excellent verbal and written communication skills

• • Excellent customer service orientation

• • Proven team player and team building skills

• Ability and flexibility to assume responsibilities and tasks in a constantly changing work environment

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington residents is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Title: Registered Nurse Caseload Coverage Specialist

Location: Orlando FL US

Job Description:

Description

CircleLink Health is seeking passionate, tech-savvy registered nurses to work remotely and serve patients enrolled in Medicare’s Chronic Care Management Program.

In this part-time role (20-25 hours per week), the Remote RN Caseload Coverage Specialist will manage their own small caseload of patients at the start of each month and assist fellow nurses with their caseloads during the latter half of the month in an effort to consistently exceed our company-wide goal of serving 95% of our patient population.

• Utilize our specialized care management software to call Medicare patients with 2 or more chronic conditions (Diabetes, CHF, Chronic Pain, COPD, etc.) on a monthly basis.
• Promote positive patient heath outcomes and ensure continuity of care by managing patient contact in cases where patient’s primary nurses are unavailable.
• Build and maintain rapport with patients to help coach them to improved health through SMART goals and education on self-management strategies.
• Implement and improve the Plan of Care by updating medications, appointments due, biometrics, symptoms, and interventions made.
• Connect patients with community resources as needed, including transportation, personal care needs, prescription/DME assistance, social services, etc.
• Conduct Transitional Care Management activities for high-risk patients discharged from the hospital and the ER to reduce unnecessary readmissions.
• Close care gaps by encouraging and assisting with preventive care measures, i.e., annual well visits, vaccines, cancer screens, follow-up/specialist appointments, etc.
• Provide flexible support to fellow nurses by assisting with their caseloads during the second half of the month.

Requirements

Requirements:

• Fluent in English.
  • Spanish-speaking is a plus!
• Self-directed, able to work independently with little supervision while meeting performance metrics.
• Flexible, adaptable, and available to provide immediate assistance nurse peers throughout the month
• Thrive in a dynamic setting, embracing the unique and varied experiences that come with each workday, where no two days are the same.
• Willingness to take on additional tasks and responsibilities as needed to support the team.
• Passion for nursing and improving patient outcomes.
• Good with technology and eager to learn and use new software.
• Excellent organizational and time management skills.
• Strong communication and telephonic skills.
• Strong critical thinking and problem-solving skills.

Education and Experience:

• Current COMPACT nursing license
• Proficiency with electronic health records and web-based applications.
• 3+ years experience as a Registered Nurse.

Preferred Education and Experience, but not required:

• Case Management or Chronic Disease Management experience.
• Certified Diabetes Educator.
• Experience with Motivational Interviewing or other behavior change communication techniques.
• Scheduling and Other Requirements:
• RN needs a STRONG internet-connected computer.
• Minimum of 20-25 hours of availability per week required.
• Ability to manage a small caseload at the beginning of each month.
• Open availability during the second half of the month to assist fellow nurses.
• You will commit to your own schedule using our software.
• Work must be completed on weekdays between 9am-6pm.
• This is a 1099 contract position with no end date. Care coaches are responsible for their own taxes and insurance.

Benefits

Compensation:

Care Coaches can earn up to $45.00 per hour. Compensation is paid at the rate of $15.00 per initial Clinical Encounter per patient per month. A clinical encounter occurs after two criteria are met: a patient has a successful clinical call and the patient has 20 minutes or more of time in their chart timer.

Ex: If in one hour you called and spoke 3 patients and spent 20 minutes with each of them, your pay for that hour would be $45.00 per hour ($15.00/pt reached x 3)

Ex: If in one hour you called and spoke with 2 patients and spent 30 minutes with each of them, your pay for that hour would be $30.00 ($15.00/pt reached x 2).

Pay Timing:

Monthly via direct deposit, 40 days after the last day of the month of service. This is due to the time it takes Medicare to process reimbursements, but your monthly pay is guaranteed after the month is over.

Billing Specialist

locations

Remote – Nationwide

time type

Full time

job requisition id

R020657

Thank you for considering a career at Ensemble Health Partners!

Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.

Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference

The Opportunity:

The Billing Specialist performs daily billing tasks such as: Works daily failed bill, failed claims on host system and failed claims within billing vendor. Works late charges, re-bill’s, & any additional assigned reports. Updates to Excel reports capturing status of accounts billed/not billed. Pulls documents for audits updating tracking sheets of the audit status. Prints and mails hardcopy claims along with any additional documentation need with the claims. Ensures the Company is meeting regulatory compliance requirements.

Essential Job Functions

• Reviews/Updates failed bills & claims on host system and within billing vendor. Works daily electronic 277’s resolving claim issue’s.
• Works daily late charges & rebills.
• Bills hardcopy claims attaching any needed documentation for payment.
• Pulls EOB’s and Medical Records as needed attaching to claims and mailing.
• Contact patients, insurance, any third party for insurance information or any additional billing data.
• Contact patient and third parties for needed billing information.
• Performs rebill projects and additional daily reports.
• Assists with creation/up keep of training documents

Other Preferred Knowledge, Skills and Abilities

Minimum Years and Type of Experience:

• Accredited degree or equal experience in hospital billing.
• Must have billing experience on multiple payers or a SME for one payer.
• Must demonstrate basic computer knowledge and demonstrate proficiency in Microsoft Excel.
• Must pass typing test of 35 words per minute (error adjusted).

Minimum Education:

• High School Diploma or GED. Combination of post-secondary education and experience will be considered in lieu of degree.

Certifications:

• CRCR within 9 months of hire (Company Paid)

Join an award-winning company

Three-time winner of “Best in KLAS” 2020-2022

2022 Top Workplaces Healthcare Industry Award

2022 Top Workplaces USA Award

2022 Top Workplaces Culture Excellence Awards

• Innovation
• Work-Life Flexibility
• Leadership
• Purpose + Values

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:

• Associate Benefits – We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
• Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
• Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble Health Partners provides reasonable accommodations to qualified iniduals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact [email protected].

Remote Pro-Fee Coder – Anesthesiology

locations

US – Remote (Any location)

time type

Full time

job requisition id

20752

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

The Anesthesia Coder, codes anesthesia documents and/or charge tickets as assigned. If requested by supervisor, provides technical guidance and training on medical coding to physicians and/or other department staff. Maintains knowledge of AMA guidelines and billing compliance and performs all other duties as required.

Must be self-directed and self-motivated; must have good communication and interpersonal skills. Must be detail oriented, accept responsibility for the direction, control and planning of one’s own work; recognize the rights and responsibilities of patient and employee confidentiality; adaptable to change and improvement; relate to others in a manner which creates a sense of teamwork and cooperation; show exemplary attitude in levels of maturity, responsibility, judgment and conduct exhibit flexibility and cope effectively in an ever-changing, fast-paced healthcare environment; perform effectively when confronted with emergency, critical, unusual or dangerous situations; and demonstrate the quality work ethic of doing the right thing the right way. This position is full time and 100% remote.

What You Will Do:

• Assigns case numbers to special billing charges if applicable or sends to research as needed.
• Assigns required CPT/ICD/ASA/HCPCS codes and/or modifiers as needed per documentation.
• Identifies missing information and gives to appropriate party for follow up.
• Resolves TES edits as required.
• Has specific job knowledge to perform assigned job functions, including all applicable computer programs?
• Attends required in-service training, various committees, department, and other appropriate meetings related to medical coding issues.

Quality Assurance:

• Meets or exceeds quality assurance standards as defined by management for work assigned.
• Admits mistakes, makes corrections, and works to prevent future occurrences.
• Maintains all coding certifications.

Productivity:

• Meets or exceeds productivity standards as defined by management for work assigned.
• Meets assigned deadlines/turnaround time.
• Performs tasks efficiently and assumes more work when possible.
• Works with management to ensure workflow is maintained and effective.

Communication:

• Openly exchanges information with co-workers in a timely manner.
• Respects the confidentiality of information in the workplace.
• Provides coding/technical guidance to physicians and other departmental staff in identifying and resolving issues or errors, such as incomplete or missing records and documentation, ambiguous or non-specified documentation, or codes that do not conform to approve coding principles/guidelines.
• Informs others as needed in a clear, concise manner; selects the proper mode of communication and includes appropriate parties.
• Notifies supervisor promptly when problems arise with equipment, programs, etc.

Ethics and Compliance:

Employee performs within the prescribed limits of the company’s Ethics and Compliance program and is responsible to detect, observe and report compliance variances to their immediate supervisor, or upward through the chain of command, the Compliance Officer or the compliance hotline. Employee completes all required annual compliance education.

What You Will Need:

• High School Diploma/GED or 3 years of relevant equivalent in lieu of diploma/GED
• 1-3 years Anesthesia Coding Experience
• Certified Professional Coder Certification (CPC) or a comparable coding certification (e.g., AHIMA CCS-P)

What Would Be Nice to Have:

• 4 years Anesthesia Coding Experience
• AAPC Anesthesia and Pain Management Coder Certification (CANPC)

Additional Requirements

• The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.

The annual salary range for this position is $43,400.00-$65,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a erse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Utilization Review Nurse- FT (9a-9p EST)- 8HR Shift

remote type

Fully Remote

locations

Remote – Other

time type

Full time

job requisition id

R012857

Responsible for utilization review work for emergency admissions and continued stay reviews.

Responsibilities

• Review electronic medical records of emergency department admissions and screen for medical necessity, using InterQual or MCG criteria.
• Participate in telephonic discussions with emergency department physicians relative to documentation and admission status.
• Enter clinical review information into system for transmission to insurance companies for authorization.

Qualifications

Required

• Current RN licensure
• At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
• At least 2 years utilization management experience in acute admission and concurrent reviews
• Intermediate level experience with InterQual and/or MCG criteria within the last two years
• Proficiency in medical record review in an electronic medical record (EMR)
• Experience in MS Office and basic Excel
• Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs
• Passing score(s) on job-related pre-employment assessment(s)

Preferred

• 3+ years utilization management experience within the hospital setting
• Bachelors of Science in Nursing
• Proficient in InterQual/MCG criteria
• Case Management Certification (CCM, ACM, CMCN, or CMGT-BC

Expectations

• This job operates in a remote environment that must be private. This role routinely uses standard office equipment such as computers, phones, and printers.
• Hours will vary, including two weekends a month.
• Must be able to remain in a stationary position 50% of the time and constantly operate a computer.
• Frequently communicates with internal, external and executive personnel and must be able to listen and exchange accurate information.

Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all iniduals. We celebrate ersity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the inidual can provide proof of valid prescription to Netsmart’s third party screening provider.

If you are located in a state which grants you the right to receive information on salary range, pay scale, description of benefits or other compensation for this position, please use this form to request details which you may be legally entitled.

All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position.

Netsmart’s Job Applicant Privacy Notice may be found here.

Billing & Administrative Specialist

FULL TIME • FULLY REMOTE – US

Benefits:

• 401(k)
• Competitive salary
• Health insurance
• Home office stipend
• Paid time off

Billing & Administrative Specialist

We are seeking an experienced Billing and Administrative Specialist to oversee the financial and administrative operations of our mental health clinic. The ideal candidate will have a strong background in medical billing and coding, along with excellent organizational and communication skills to effectively manage client interactions and administration.

Responsibilities:

• Manage all aspects of billing and collections for services provided, including insurance claims processing, payment posting, and follow-up on outstanding accounts.
• Ensure accurate coding of services rendered and adherence to billing regulations and guidelines.
• Handle inquiries and resolve issues related to billing, insurance coverage, and payments from clients and insurance companies.
• Maintain up-to-date knowledge of insurance policies, billing procedures, and coding updates to optimize reimbursement and minimize billing errors.
• Oversee the day-to-day administrative operations of the clinic, including scheduling appointments and managing client records
• Coordinate with clinicians and clinical director to streamline workflow processes and ensure efficient delivery of services.
• Collaborate with external vendors, such as billing software providers and insurance companies, to resolve technical issues and improve billing efficiency.
• Assist with preparing financial reports and analyses to monitor clinic revenue, expenses, and performance metrics.
• Assist with other administrative tasks and projects as needed to support the overall functioning of the clinic.

Qualifications:

• Minimum of 2-3 years of experience in medical billing and coding, preferably in a mental health setting.
• Proficiency in medical billing software and electronic health record (EHR) systems. Experience with Valant EHR a plus.
• Strong understanding of insurance claims processing, billing regulations, and coding standards (e.g., CPT, ICD-10).
• Excellent attention to detail and accuracy in data entry and record-keeping.
• Effective communication skills, both written and verbal, with the ability to interact professionally with clients, staff, and external stakeholders.
• Some understanding of client scheduling in a clinical setting.
• Proficient in the use of typical office technology (computers, e-mail, etc.). Experience with Microsoft 365 a plus.
• Proven ability to multitask, prioritize tasks, and meet deadlines.
• Strong leadership and interpersonal skills.
• Ability to maintain confidentiality and handle sensitive information with discretion.
• Commitment to providing exceptional customer service and promoting a positive clinic environment.
• Desire to work in a collaborative atmosphere that embodies Ellie’s values (creativity, authenticity, humor, compassion, acceptance, determination);

What we have to offer:

• Competitive salary, excellent benefits and paid time-off
• Flexible scheduling

What else you should know:

• Ellie Mental Health is a highly successful multi-clinic mental health organization originally based in Minnesota; however, Ellie in Boise is locally owned and operated. The owner and Director are lifelong Idahoans committed to expanding mental health services in our community. Our vision is to operate a small but mighty clinic with a dedicated team of kickass therapists and staff who support one another in providing excellent services to our clients and the larger community.

This is a remote position.

Compensation: $45,000.00 – $48,000.00 per year

Title: Customer Liaison Nurse

Location: Any state, US

Company: New York Life Insurance Co

Location Designation: Fully Remote

Job Description:

When you join New York Life, you’re joining a company that values career development, collaboration, innovation, and inclusiveness. We want employees to feel proud about being part of a company that is committed to doing the right thing. You’ll have the opportunity to grow your career while developing personally and professionally through various resources and programs. New York Life is a relationship-based company and appreciates how both virtual and in-person interactions support our culture.

GBS

A career at New York Life offers many opportunities. To be part of a growing and successful business. To reach your full potential, whatever your specialty. Above all, to make a difference in the world by helping people achieve financial security. It’s a career journey you can be proud of, and you’ll find plenty of support along the way. Our development programs range from skill-building to management training, and we value our erse and inclusive workplace where all voices can be heard. Recognized as one of Fortune’s World’s Most Admired Companies, New York Life is committed to improving local communities through a culture of employee giving and service, supported by our Foundation. It all adds up to a rewarding career at a company where doing right by our customers is part of who we are, as a mutual company without outside shareholders. We invite you to bring your talents to New York Life, so we can continue to help families and businesses “Be Good At Life.” To learn more, please visit LinkedIn, our Newsroom and the Careers page of www.NewYorkLife.com.

Role Summary:

The LPN is a professional that works with a multidisciplinary team of other Nurses, Behavioral Health Specialists, Physicians, Claim Managers and/or Vocational Coaches. The LPN is relied upon to assist with telephonic assessment of a customer’s functionality from a holistic point of view, build a rapport with the customer, as well as gather pertinent information from the customer and /or treating providers. The ideal candidate will possess the desire to grow within the organization, as the LPN role provides the opportunity for employees to be exposed to and acquire skills to do so.

QUALIFICATIONS

• Licensed Practical Nurse with current unencumbered LPN licensure in the U.S.
• Minimum of 3 years clinical experience with strong clinical background in at least one or more of the following: Medical/Surgical, Occupational Health, Rehabilitation, Psychiatric, Critical Care, or Public Health Nursing
• Ability to function in a team environment
• Proficient computer skills to include the ability to navigate independently and knowledge in Microsoft Outlook, Windows, Excel, and Word
• The ability to multitask such as talking while typing and working on variety of applications and/or computer monitors simultaneously
• Strong written and verbal communication skills
• Timely, clear, concise documentation and communication
• Attention to fine detail
• Excellent organizational and time management skills
• Strong critical thinker
• The ability to diffuse difficult or challenging situations
• Comfortable giving and receiving feedback
• Flexible to an ever changing environment
• Ability to work independently with a sense of urgency and customer-focus mindset

Training & Development:

The LPN will undergo a comprehensive paid training program. Coaching and feedback is provided to help gain the necessary skills to be successful.

Schedule information:

This is a full-time work from home position Monday through Friday. Candidates must be available to work 8 hour shifts from 8am-430pm or 830am-5pm.

Salary:

Competitive full-time base salary

Benefits:

Paid Vacation, Health Care, 401K match, Tuition Assistance, Flexible Spending Accounts

Career Opportunities:

New York Life offers a variety of career opportunities

It is recommended that all qualified candidates apply to this posting as soon as possible. Residents of Colorado are hereby notified that the deadline to apply is 2 weeks from the Posting Date listed above.

Salary range: $45,000-$60,000

Overtime eligible: Nonexempt

Discretionary bonus eligible: Yes

Sales bonus eligible: No

Click here to learn more about our benefits. Starting salary is dependent upon several factors including previous work experience, specific industry experience, and/or skills required.

Recognized as one of Fortune’s World’s Most Admired Companies, New York Life is committed to improving local communities through a culture of employee giving and volunteerism, supported by the Foundation. We’re proud that due to our mutuality, we operate in the best interests of our policy owners. We invite you to bring your talents to New York Life, so we can continue to help families and businesses “Be Good At Life.” To learn more, please visit LinkedIn, our Newsroom and the Careers page of www.NewYorkLife.com.

Job Requisition ID: 90184

Title: Utilization Management Nurse Reviewer

(Remote, LPN Required)

Location: Remote Remote US

Job Description:

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information to determine the necessity and appropriateness of medical procedures, tests, and treatments.

Utilization Management Nurse Reviewers collaborate with healthcare providers, insurance companies, and patients to optimize healthcare delivery, control costs, and maintain quality care. Their responsibilities include assessing medical necessity, coordinating care, conducting utilization reviews, providing recommendations for care plans, and ensuring adherence to regulations and guidelines. This role requires strong clinical knowledge, critical thinking skills, communication abilities, and the ability to make informed decisions regarding patient care pathways.

MAJOR DUTIES & RESPONSIBILITIES

• Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria).
• Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services.
• Offer clinical expertise and serve as a clinical reference for non-clinical staff members.
• Input and manage essential clinical details within various medical management platforms.
• Keep up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review.
• Apply clinical reasoning to determine the suitable evidence-based guidelines.
• Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director.

Requirements

• Proficient in both written and spoken communication.
• Capable of maintaining professional communication with physicians and clients.
• Skilled at handling multiple tasks and adjusting swiftly in a dynamic office setting.
• Possesses a keen organizational sense and pays close attention to details.
• Adept at resolving intricate and multifaceted problems.
• Experienced with Microsoft tools such as Word, Excel, PowerPoint, and Outlook.
• Background in medical or clinical practice through education, training, or professional engagement.
• Holds an unrestricted LVN/RN license from an accredited vocational nursing program (for LVNs) or a nursing degree from an accredited college (for RNs).

Additional Duties

• May provide oversight to the work of the team members.
• Continuously improves processes that help to facilitate better turnaround time, peer to peer success rates and lessens returned reports by clients for clarification purposes, ultimately resulting in higher client satisfaction.
• Responsible for the final approval on cases for release to the client.
• Will act as a liaison and coordinate quality issue reports along with all new reviewer reports with the VP of Clinical Operations.

EDUCATION/CREDENTIALS:

Licensed Practical/Vocational Nurse with an active and unrestricted license to practice.

JOB RELEVANT EXPERIENCE:

2 yrs minimum clinical nursing experience is required.

One year of previous experience in Utilization Management is required.

JOB RELATED SKILLS/COMPETENCIES:

Demonstrate strong abilities in both spoken and written communication, along with effective interpersonal skills. Possess a proficient understanding of computer operations, particularly the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows. Show the capability to acquire new skills and competencies to address the evolving requirements of systems, software, and hardware.

WORKING CONDITIONS/PHYSICAL DEMANDS:

Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work.

WORK FROM HOME TECHNICAL REQUIREMENTS:

Supply and support their own internet services.

Maintaining an uninterrupted internet connection is a requirement of all work from home position.

Requirements

Beginning compensation will depend on several factors including the candidate’s experience, education, and specific skills. In addition to the base salary, we offer a comprehensive benefits package including health insurance, retirement plans, and performance bonuses.

Our Commitment:

We are committed to providing fair and competitive compensation that reflects each employee’s contributions and performance. We value ersity and strive to create an inclusive environment for all employees.

Salary: $45,000 – $70,000 USD

Benefits

Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.

ABOUT DANE STREET:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

Title: Utilization Management (UM) Nurse Clinical Reviewer – LPN/RN (Remote U.S.)

Location: Indianapolis IN US

Job Description:

CNSI and Kepro are now Acentra Health! Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the company’s mission, actively engage in problem-solving, and take ownership of your work daily. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate iniduals dedicated to being a vital partner for health solutions in the public sector.

Acentra seeks a Utilization Management (UM) Nurse Clinical Reviewer – LPN/RN (Remote U.S.) to join our growing team.

Job Summary:

The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements, critical thinking, and decision- making skills to determine medical appropriateness.

Job Responsibilities:

• Performs all applicable review types as workload indicates accurately and timely. These may include both inpatient and outpatient review types.
• Utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements, critical thinking and decision-making skills to determine medical appropriateness.
• Performs all applicable review types as workload indicates, accurately and timely. These may include both inpatient and outpatient review types.
• Determines approval or initiates a referral to the physician consultant and processes physician consultant decisions ensuring reason for the denial is described in sufficient detail on correspondence.
• Assures accuracy and timeliness of all applicable review type cases within contract requirements.
• Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department.
• In collaboration with Supervisor, responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas.
• Maintains current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns.
• Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution.
• Performs all applicable review types as workload indicates.
• Fosters positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
• Attends training and scheduled meetings and for maintenance and use of current/updated information for review.
• Cross trains and perform duties of other contracts to provide a flexible workforce to meet client/customer needs.

Requirements

Required Qualifications/Experience:

• Active unrestricted Indiana Licensed Practical Nurse (LPN) OR Registered Nurse (RN) OR other applicable State and/or Compact State clinical license per contract requirements.
• Graduate of an accredited Diploma, Associate, or Bachelor’s Degree Nursing Program.
• 2+ years of Utilization Management (UM) experience from the State, Hospital, or Health Plan.
• Knowledge of InterQual or MCG (Milliman) criteria.
• Knowledge of current NCQA/URAC standards.
• 2+ years of relevant clinical experience.
• Knowledge of the organization of medical records, medical terminology, and disease process.
• Strong clinical assessment and critical thinking skills required. Medical record abstracting skills required.
• Must be proficient in MS Office and internet/web navigation.

Preferred Qualifications/Experience

• Experience with State Medicaid programs.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people’s lives nationwide. Our company cares about our employees, giving you the tools and encouragement you need to achieve the finest work of your career.

Benefits are a key component of your rewards package. Our benefits are designed to provide additional protection, security, and support for your career and life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The pay range for this position is $58,240-$74,880 annually.

“Based on our compensation program, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.”

Thank You!

We know your time is valuable, and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may interest you. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra.com/careers/

EOE AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.https://acentra.com/careers

Title: Nurse Care Navigator

Location: Remote

Type: Full-time

Category: Operations

Job Description:

Sana’s vision is to make healthcare easy.

All of us can agree healthcare is simply too hard in the US. And our members feel that pain day in and day out. We aim to create an experience that simply feels easy when you need to access our healthcare system. If you need something, you know where to go to get it with care that is a click (or as few clicks as possible!) away.

What’s beautiful about a vision oriented toward “easy” is how it imparts a singular feeling. We instinctively know as humans when something is easy versus hard, even if we can’t explain why. We fight as a company to make an easy pathway available to all our members at every stage of their healthcare journey. If you feel passionate about delivering better healthcare to small businesses through a seamless care experience and affordable benefits, join us!

We are looking for a hard-working, empathetic person to join our Case Management team. We’re building a team of nurses to guide our members with complex and chronic care needs through the complicated healthcare system to ensure they receive the right care, in the right setting, at the right time. This is a remote position, but we do require that you have unencumbered licensure as a Registered Nurse in Texas, and are eligible for licensure in any US state.

What you will do

• • Provide clinical navigation support for our internal health plan team to include but not limited to: condition education, care options, and planning, care compliance, medication adherence, shared decision support, and care coordination
  • Proactive outreach engagement of high-risk, rising-risk, and gap-in-care members to help them best navigate their healthcare journey
  • Manage the partnership with our external UM and RN Case Managers to ensure high quality, prompt utilization review, successful case management engagement, and high-value care navigation
  • Act in the best interest of the member by being a health advocate and supporter in the member’s healthcare journey
  • Build relationships with clinical contacts at Sana’s partners to provide streamlined referral pathways for care navigation
  • Assist with all post-op coordination of care and member support for patients who utilize our surgical care partners
  • Help identify provider contracting opportunities for network development to improve member access
  • Monitor and evaluate the effectiveness of care navigation and adjust as necessary utilizing clinical knowledge, evidence-based guidelines, and operational key performance indicators.
  • Collaborate cross-functionally with Underwriting and Claims Operations to offer a clinical perspective on certain high-cost claimants.

About you

• • Bachelor’s degree in a health-related field with at least 3 years of clinical experience. Case management or clinical care navigation experience preferred
  • Active and unencumbered licensure as a Registered Nurse in Texas. A compact license is preferred. Eligibility for licensure in any US state.
  • Experienced in remote work
  • Excellent clinical, organizational and communication skills
  • Entrepreneurial. Self-directed. Excited to build something from scratch
  • Values-oriented. You care about making our healthcare system work better for people and business owners
  • Gritty. You aren’t worried about getting your hands dirty and working hard when you need to
  • Comfortable with change. We are a startup and need people who are ok doing things outside of their traditional job description
  • Comfortable with modern web applications. We are building all of our software in-house and you will be a key constituent in its development

$80,000 – $85,000 a year

Our cash compensation amount for this role is targeted at $80,000 – $85,000 per year for all US-based remote locations. Final offer amounts are determined by multiple factors including candidate experience and expertise and may vary from the amounts listed above.

Sana is a modern health plan solution for small and medium businesses. We use a more efficient financing structure and integrated technology solutions to cut out wasteful spending and get members access to better quality care at lower costs. Founded in 2017, we are an experienced team of engineers, designers, and health system operators. We have the financial backing of Silicon Valley venture firms and innovative reinsurance partners. If you are excited about building something new and being a part of fixing our broken healthcare system from the inside, please reach out!

Title: Sr. Supervisor, Infusion Nursing – Accredo – Kent, WA

Location: OR-Salem

Job Description: Candidates for this position should reside in Washington or Oregon, and will supervise nurses working throughout Washington, Oregon, western Idaho & Alaska.

**This is a hybrid role between Work at Home, field visits and possibly in-office requirement based on location.**

**What You’ll Do** **:**

+ Provide specialized infusion therapies and clinically excellent professional nursing services to patients and caregivers at home or in alternate settings.

+ Supervise daily nursing activities and ensure quality patient care, as directed by the Nurse Manager.

+ Ensure RNs are knowledgeable of the patient’s disease state, trained/educated on the medication and have demonstrated competency in use of ancillary supplies/pump/access devices.

+ Conduct skills return demonstration and supervisory visits for all RN staff announced and unannounced to assess delivery of quality patient care in a clinical setting.

+ Supervise receipt, evaluation, acceptance and execution for the initial patient intake process to ensure that patient verification, assessment, teaching and the ongoing scheduling of nursing service occurs in a timely appropriate manner.

+ Monitor the daily nurse scheduler application to ensure nursing team is compliant with nursing note submission, availability and completion of plans of treatment.

+ Supervise the completion of all patient-related documentation to ensure accuracy, timeliness, and regulatory compliance.

+ Identify operational opportunities and areas for process development, improvement and administration applicable to clinical product offerings and present recommendations to leadership.

**What You’ll Need** **:**

+ Registered Nurse (RN) license in good standing in the state of residence

+ BSN degree, plus 2+ years of relevant RN experience; or

+ ASN degree, plus 5+ years of relevant RN experience; or

+ Nursing Diploma, plus 8+ years of relevant RN experience

+ 1+ years of experience in critical care, acute care, or home care/home infusion environment

+ 2-3 years supervisory experience is required

+ Strong IV insertion skills

+ Previous home infusion / home healthcare experience strongly preferred

+ Solid understanding of the health insurance industry

+ Ability to navigate and support both public and private insurance/plan requirements

+ Managed care exposure

+ Understanding or ability to implement utilization management principles

+ Excellent verbal and written communication and presentation skills

+ Proficient use/navigation of Microsoft and Apple technology

+ Ability to work Monday-Friday, but also have evening and weekend flexibility, as needed

+ Ability to travel up to 10%

**Your Benefits as an Accredo Home Infusion Sr. Supervisor** **:**

+ Medical, Prescription Drug, Dental, Vision, and Life Insurance

+ 401K with Company Match

+ Paid Time Off and Paid Holidays

+ Bonus Eligibility

+ Mileage reimbursement

+ Internal Career Training Resources

+ Tuition Assistance

Accredo, Evernorth Health Services’ specialty pharmacy, serves patients with complex and chronic health conditions, including Pulmonary Arterial Hypertension, cancer, hepatitis C, HIV, bleeding disorders, and multiple sclerosis.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 78,300 – 130,500 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .

**About Evernorth Health Services**

Evernorth Health Services, a ision of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._

_If you require reasonable accommodation in completing the online application process, please email:_ [email protected]_ _for support. Do not email_ [email protected]_ _for an update on your application or to provide your resume as you will not receive a response._

_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._

Psychiatric Mental Health Nurse Practitioner – California Licensed (Remote)

Location

Remote – United States

Type

Full time

Department

Clinical

We believe that mental health is just as important as physical health. We recognize that mental health issues can be complex and multifaceted, and we are dedicated to treating the whole person, not just the symptoms.

We aim to create a world where mental health is no longer stigmatized or marginalized, but rather is embraced as an integral part of one’s overall well-being.

We believe that by providing quality care that is both evidence-based and compassionate, we can empower iniduals to take charge of their mental health and achieve their full potential. We are passionate about making a positive impact on the lives of those struggling with mental health issues and we strive to be a force for positive change in the field of mental healthcare.

We’re looking for high-quality board-certified Psychiatric Mental Health Nurse Practitioners (PMHNP) to join our telehealth practice.

Salary range: $160,000 to $280,000k*

*Our target compensation is $187,000 for clinicians that are billing 33 clinical hours a week and taking their generous paid time off. The range is a function of how many weekly visits are done, documentation and billing practices reflecting complexity and services provided.

Our Telehealth Practice

We’re committed to building a comprehensive, modern psychiatric clinic delivering patient care at the highest quality standards.

What sets us apart

• Comprehensive support: Our team of virtual care associates, nurses, and care coordinators take on all non-clinical tasks so you can focus on providing quality patient care.
• Flexibility: Our clinic hours allow you to see patients at times that fit your schedule. We offer 8 and 10 hour shifts M-F from 7am to 7pm PST. Additional clinic hours coming soon!
• Work/life balance: Clinicians have time to see your patients AND provide quality care. Your schedule includes admin time, assistive charting technology, daily new patient maximums and a thoughtful provider ramping schedule.
• Clinical Leadership: Our psych services leaders understand what it is like to be a clinician because they are providers, too!
• Innovation: We utilize measurement based care practices to ensure that you and your patients are able to see the results of the care you are providing. We are are building the technology and tools to empower clinicians and patients across every step of their journey.

You’ll get:

• Administrative support: We find patients, get them scheduled, and handle everything related to insurance and billing. Plus, our support team is on hand to answer any questions you or your patients have.
• Technology for efficient documentation: Every PMHNP gets a subscription to a medical autoscribe to aid in note-taking. With this tool, our team sees up to an 80% reduction in documentation time.
• Coordinated care: Our in-house team connects your patients with the help they need, whether that’s a higher level of care escalation or a rematch to another clinician.
• Investments in your development: In addition to an annual stipend for continuing education, our team collaborates to share best practice guidelines and insights to ensure high quality of care for Rula patients.

You Will:

• Provide clinical consultations with clients seeking mental health care including diagnostic assessments, psychiatric workup, treatment planning including medication management
• Work with iniduals who are struggling with mental health issues such as depression, anxiety, ADHD, trauma, and addiction
• Have access to our EHR & telehealth platform

• Have adequate time to engage with patients — half-hour sessions for follow-ups and 1 hour for initial consultations.

• Engage in collaborative case conferences and clinical team culture as well as collaborative TRAVEL”>TRAVEL”>meetings with an MD
• Abide by our policies and procedures, including timely completion of documentation/charge slips, participation in quality audits, and using measurement-informed care as part of the treatment of your patients

Minimum Qualifications:

• 2+ years experience as a psychiatric Nurse Practitioner
• Experience with mental health assessment, diagnosis, triage, managing common psychiatric medication and treatment plans, and managing crisis situations
• Certified by the ANCC as a PMHNP
• Looking for a full-time job that requires 33 bookable hours per working week
• A valid nurse practitioner furnishing license issued by the California BRN.
• Master’s or doctoral degree from an accredited university or graduate program in psychiatric mental health nursing
• Valid/active DEA (any state) with the ability to prescribe schedule II-V medications
• Willing and able to explore 103B independent practice in California
• Comfortable working independently and proficient with technology, EHR, and telehealth best practices
• Experience and ability to work with adult or adolescent(13y-17y) populations (with appropriate experience)
• Deeply empathetic and skilled at building a rapport with your clients
• No suspension/exclusion/debarment from participation in federal healthcare programs (e.g., Medicare, Medicaid, SCHIP)
• No adverse actions by any nursing board, hospital, or other credentialing body in the past 2 years

We’re serious about your well-being! As Part Of Our Team, Full-Time Employees Receive

• 100% remote work environment from anywhere in the US
• Competitive pay and benefits that don’t change based on location
• Health benefits: medical, dental, vision, life, disability, and FSA/HSA
• Access to our 401(k) plan
• Generous time off policies, including 2 company-wide shutdown weeks each year (for most employees) to focus on self-care
• Paid parental leave
• Employee Assistance Program (EAP)
• Stipend to ensure your home office sets you up for success
• Quarterly department stipend for team building or in-person TRAVEL”>gatherings
• Wellness events and lunch & learns spanning many topics

TeleHealth Diabetes Nurse Manager

Location

Remote

Type

Full time

Department

Science & MedicineClinical Care

Compensation

• Estimated base salary$87K $96K

Virta is an online specialty medical clinic that reverses type 2 diabetes, pre-diabetes, and obesity safely and sustainably without the risks, costs, or side effects of medications or surgery. Our innovations in the application of nutritional biochemistry, data science, and digital tools–combined with our clinical expertise–are shifting the diabetes treatment paradigm from management to reversal.

Virta has developed a novel, team-based care model that delivers the Virta treatment exclusively through a telemedicine platform, with no brick-and-mortar clinics. Our clinical trial, which has already producedsix peer-reviewed publications, shows that the Virta treatment has lowered hemoglobin A1c values under the diabetes threshold while discontinuing diabetes medications.

The American Diabetes Association has endorsed the core component of the Virta treatment, personalized carbohydrate restriction, as a first-line nutritional therapy for people with type 2 diabetes.

Weve been reversing diabetes for the last seven years, we see patients in all 50 states, and we are expanding our reach to patients with pre-diabetes and obesity. Our mission: Reverse type 2 diabetes in 100 million people.

To achieve that mission, Virta is looking for an experienced leader to help build and manage this new Team of RN CDE’s as a player-coach.

Calling out two key requirements of the role:

1. You must hold an active RN license in a Nursing Compact state.
2. In your application you must demonstrate that as a manager, you have helped your direct reports improve their skills and develop their careers, hired for quality and counseled people out, and built team cohesion and rapport.

Responsibilities:

• Build and manage a team of 10-15 outstandingpart-timenurses, including managing QA/QI, supervision, scheduling, and working with our administrative team to manage licensure of team members.
• Be a player coach: spend approximately half your time seeing patients and half your time managing the team.
• Conduct 20-minute clinical intake visits with prospective patients via video and/or phone. Intakes include verifying and documenting a clinical history, verifying medications, answering basic questions about Virta treatment, and identifying and flagging concerning history or labs for provider review.
• Educate patients about Virta and Virtas treatment and helping them prepare for their nutritional and behavioral journey with Virta, setting them up for clinical success.
• Management activities will include, but are not limited to:
  • Daily Schedule hygiene for assigned nursing team to enhance applicant throughput.
  • Monitoring and assigning provider support requests and initiatives.
  • Providing updates to clinical intake workflow
  • Delivery of just in time feedback as needed
  • Weekly POD meeting with team
  • Working with Head of Nursing and Clinical leads on developing

and implementing quality initiatives.

• Commitment to providing care of the highest quality that delivers an exceptional experience for the patient

Requirements

• Minimum of 2 experience working with diabetes patients in a clinical setting
• Interest and knowledge of diabetes care, diabetes prevention, and low carbohydrate nutrition.
• 3+ years experience managing nurses ideally in an ambulatory,virtualpractice, or in a clinical diabetes setting.
• Active RN license with at least one year of clinical experience working with patients with type 2 diabetes. CDE licensure preferred but not required
• Active RN license in, and resident of, a Nursing Licensure Compact state
• Associate orBachelor’sRN Nursingdegreefrom an accredited school or university
• Eligible for licensure in every U.S. state.
• Interest and aptitude for working with a growth stage, tech-enabled healthcare organization
• Occasional (2-3x/yr)travelto team and company events.
• An outstanding bedside manner: patients trust you and feel supported and empowered by your presence on the phone/video and your communication.
• Team player: You work well with others, put your team first, and contribute toward the betterment of the Virta clinical team.

Senior Coder – Anesthesia

Remote

Full time

34528

Position: Senior Coder-Anesthesia

Department: FPF Prof. Billing Office

Schedule: Full Time

POSITION SUMMARY:

The Physician Practice Coder II-Anesthesia position is responsible for reviewing documentation in the outpatient/inpatient EHR. This position is responsible for assigning ICD-10-CM diagnosis codes and CPT, ASA, HCPCS II and appropriate modifiers to patient records from BMC Anesthesia Departments. The Physician Practice Coder II Anesthesia position is a resource for the physicians and other health care providers in regard to coding and to review medical documentation to insure appropriate physician coding and billing.

Conducts CPT and ICD-10 coding reviews by detailed examination of each line item in the physician medical record and charge session. Performs chart audits to ensure correct coding and charge capture have been applied appropriately. Works closely with key revenue cycle stakeholders to understand reasons for denials, root cause analysis, and feedback to providers.

JOB REQUIREMENTS

EDUCATION:

Associates Degree (or direct work experience equivalent to at least 2 years).

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required. Certification may include CPC, COC, COC-A, CANPC, CGSC, CIC, CCA, CPC-A, CCS, CCS-P, RHIT, or RHIA

EXPERIENCE:

Minimum of 2 years experience conducting Anesthesia coding/auditing in a surgical/procedural environment to include compliance, and billing processes.

KNOWLEDGE AND SKILLS:

• Advanced Proficiency in ICD-10, CPT, ASA, HCPCS, and modifiers for coding of professional fee services.
• Advanced knowledge of anatomy and physiology, medical terminology and insurance reimbursement policies and regulations.
• Excellent written and verbal communication skills and the ability to prioritize and organize work to meet strict deadlines are required.
• Able to code moderate/high complexity work.
• Understands, retains, and is able to research coding billing rules, regulations, and requirements.
• Able to critically think through processes in coding to recognize errors and/or problems. Understands reasons for actions on edits.
• Able to share/transfer knowledge or train co-workers, peers, billing managers on coding – Able to provide education with physicians in small group or one-on-one sessions as needed or requested.
• Able to provide feedback to billing managers, physicians, staff, and others independently with occasional guidance from manager.
• Able to provide cross-coverage of multiple specialties.
• Able to perform peer to peer quality assurance reviews in equal or lower complexity areas of expertise.
• Proficient with computer applications (MS Office etc), Excellent data entry skills
• Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.
• Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
• Ability to work with accuracy and attention to detail
• Ability to solve problems appropriately using job knowledge and current policies/procedures.
• Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests.
• Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Perform coding and related duties of moderate and high complexity anesthesia work using established guidelines in an accurate and timely manner.
• Review medical documentation and system generated charges or paper encounter forms. Appropriately assign CPT, ASA, ICD-10, HCPCS II, and modifiers based on documentation and payor requirements
• Research billing rules and regulations for moderately complex new and existing procedures
• Demonstrate a commitment to integrating coding compliance standards into daily coding practices. Identify, correct and report coding problems.
• Maintains knowledge of coding and professional skills, including maintaining yearly coding credentials through attendance at in-service programs, conferences, workshops, review of current literature and other educational programs.
• Resolves complex coding edits and denials in a timely manner. Identify opportunities to reduce denials and enhance revenue.
• Provide cross coverage of multiple specialties
• Function as a resource to external customers. Research and resolve complex coding inquiries. Make recommendations for coding policy changes.
• Perform peer to peer quality assurance reviews of all Physician Practice Coders in equal or lower complexity areas of expertise
• Functions as subject matter expert for assigned specialties
• Develop and maintain ision specific coding procedures and/or billing area instructions
• Complete special projects as assigned by manager.
• Participate in coding education for providers and co-workers upon request.
• Maintain coding certification.
• Sequences diagnoses, procedures and complications by following ICD-10-CM, Medicare, Medicaid, and other fiscal intermediary guidelines.
• Maintains productivity standards set forth in Departmental Policies and procedures.
• Review and respond to coding questions.
• Ensure billed service is being accurately coded.
• Perform random chart audits.
• Performs other duties as needed. IND12

Must adhere to all of BMC’s RESPECT behavioral standards.

Equal Opportunity Employer/Disabled/Veterans

Sr Medical Coder – Part-Time

Location: United States

Status (FT/PT): Part-Time Shift: Day shift Req ID: 59947

**Part-time, 20 hours/week; Day shift, Monday-Friday

Find more than your next job. Find your community.

• We’re northern Michigan’s largest healthcare system and we are deeply rooted in the communities we serve. That means that our patients are often our family, friends and neighbors – and it’s special to be able to care for them. And as one of the top healthcare systems to work for in Michigan by Forbes (American’s Best Employers by State 2022), we’re committed to your ongoing growth and development.
• After work, you’ll find things to do in every season – beaches, outdoor recreation, unique restaurants, world-class wineries, arts and entertainment.

Why work as a Sr Medical Coder at Munson Healthcare?

• Remote work schedule
• Our dynamic work environment includes many opportunities for growth and development
• Our efforts directly impact patient satisfaction and outcomes
• Our employees work in positive, supportive, and compassionate environments built on our organizational values.

Summary:

The facility Senior Coder/Abstractor is a critical member of the Revenue Cycle Team and is responsible for coding and abstracting inpatient and complex outpatient medical records for performance improvement, statistical research, administrative, and facility reimbursement purposes.

Coding is performed using utilizing ICD10-CM, ICD10-PCS and CPT-4 classification systems and is subject to the Official Guidelines for Coding and Reporting, AHIMA Code of Ethics “Standards of Ethical Coding”, AHA Coding Clinic and technical rules outlined by hospital guidelines.

The Senior Coder/Abstractor works closely with the Coding Analyst, Clinical Documentation Integrity Specialists, and the Regional Coding Operations Coordinator. Required qualities include teamwork, ability to code various patient types for a variety of Munson facilities, and flexibility in handling work assignments while maintaining productivity and quality standards. This position supports the timely and accurate submission of facility claims and works to achieve or exceed the established Accounts Receivable goals for the department.

What’s Required:

• Associate or Bachelor Degree in Health Information. CCS certification with a minimum of 2 years coding experience will be considered.
• Certification as a Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS) is required. New graduates must obtain certification as Registered Health Information Technologist (RHIT), or Registered Health Information Administrator (RHIA) within 12 months of hire date.
• One to three years’ previous experience using ICD10-CM, ICD10 PCS and CPT-4 coding systems is required.
• Demonstrated ability to meet productivity and quality standards is required.
• Keyboard entry skills are required.

The Benefits of Working at Munson:

• Eligible for a $2,500 Sign on Bonus
• Competitive salaries
• Full benefits, paid holidays, and paid time off (up to 19 days your first year)
• Tuition reimbursement and ongoing educational opportunities
• Retirement savings plan with employer match and personal consulting
• Wellness plans, an employee assistance program and employee discounts

Title: Clinical Assistant, Utilization Management, Medicare

Location: TN-Chattanooga

Job Description:

Supports customer service activities and initiatives for a number of products or clients including but not limited to the Case Management and Utilization Management departments.

Job Responsibilities

• Screen incoming calls and/or faxes or other digital format for UM and/or CM and direct calls/faxes/other digital requests to the appropriate area. Identify and refer cases appropriately to the Case Management and/or Transition of Care department.
• Receiving, investigating and resolving customer inquiries and claims. Maintain departmental goals. Perform projects, review and handle reports as assigned.
• Load complete organization determination/notification for services designed by internal policy. Clearly document and key data in to the appropriate system using departmental guidelines.
• Interact with membership, hospital and provider staff, advising of UM decision, status organization determinations, requesting additional or clarifying information and giving direction as necessary.
• Search for and key appropriate diagnosis and /or procedure code as part of the notification /prior authorization process.
• This job requires digital literacy assessment.
• Participation and attendance are mandatory.
• This position requires flexibility, due to rotations in schedules, and requires adherence to assigned schedules.
• Work overtime as required

Job Qualifications

Education

• High School Diploma or equivalent

Experience

• 1 year – Customer service experience is required

Skills\Certifications

• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Proficient oral and written communication skills
• Proficient interpersonal and organizational skills
• Exceptional time management skills
• Ability to work independently under general supervision and collaboratively as part of a team in a fast paced environment
• Independent, Sound decision-making and problem-solving skills
• If current employee with the company, must meet minimum performance expectations
• Extensive knowledge of all aspects of Utilization Management, Care Management, and Behavioral Health.
• Knowledge and understanding of Medical terminology
• Solid knowledge and understanding of provider reimbursement methodologies, ICD-9-CM, CPT, HCPCS and UB-92 coding, UHDDS coding guidelines, AHA Coding Clinic
• Ability to talk and type simultaneously in a clear and concise manner while interacting with customers

Job Specific Requirements:

• Training will be Monday to Friday 8-5pm EST.
• Shift hours will be Monday to Friday with the potential to start as early as 6am, after training is completed.

Preferred Skills:

Number of Openings Available:

1

Worker Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, Inc.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote iniduals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST’s EEO Policies/Notices may be found by reviewing the following page:

BCBST’s EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Tobacco-Free Hiring Statement

To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire iniduals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An inidual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

Title: Scheduling Coordinator (6-Month Full-Time Contract) (Remote)

Location: New York NY US

Category: Operations

Full-Time

$20.00 – $22.00 / hr

Job Description:

Reverence is a technology company solving one of the hardest problems in healthcare – how to get the right people, in the right place, at the right time – in support of top-quality home-based care.

We provide technology and services that enable healthcare provider groups to significantly improve staffing operations.

Our mission-driven team brings significant front-line experience driving excellence in home-based care and improving workforce operations – one of the gnarliest (and most interesting!) business challenges facing healthcare organizations.

About the Role:

The scheduling coordinator will work with home care agencies to support the most important aspects of the scheduling process. We are looking for one person to fill a 6-month contract role (approximately 40 hours per week) with the following hours: 9 am-5 pm Eastern time (Mon-Fri). This is a fully remote 6-month contract role.

This role will involve a mix of the proactive and reactive. The proactive aspects of this role will include working with care coordinators to place home care aides into long-term placements with patients. This will require taking into account both quantitative (e.g., skills and availability) and qualitative factors (e.g., personality) to make a good match.

The more reactive aspects of this role will include answering phones and escalating as needed, filling caregiver shifts on short notice, and, in general, ensuring that patients receive the assistance they need. In practical terms, the associate will coordinate with caregivers and customers to handle situations such as filling shifts with short notice (due to a call out), no shows, or lateness.

The role requires working across multiple technology systems to ensure accurate record keeping, as well as working directly with caregivers and clients, so comfort with technology, a positive attitude, a friendly demeanor and willingness to problem-solve will be important in this role.

What you’ll do:

• Interact directly with clients, caregivers and patients to handle client related matters including: working with care coordinators to place home care aides into long-term placements with patients; staffing scenarios and attendance issues (no shows, lateness); schedule changes to ensure patient/caregiver coverage; customer service complaints
• Use technology to assign clients to the appropriate clinicians
• Use a ZenDesk ticketing system to track ongoing cases and communication
• Communicate with caregivers and patients regarding any updates or changes to their schedule
• Utilize technology across multiple software systems (Google workspace and proprietary systems) to ensure the best service for all
• Handle Patient Health Information (PHI)

We are looking for:

• Effective communication skills with clients, patients, caregivers and families
• Some customer service experience – Be friendly, positive, persuasive, and solutions-oriented
• Proactive problem solver and able to handle difficult situations or customers as they arise
• Highly organized with attention to detail (i.e., able to follow clearly defined procedures)
• 2-3 years customer service, health care, hospitality, or retail experience preferred
• Strong ability to navigate multiple technology systems simultaneously
• Previous experience as a home care scheduler (or other industry front-line scheduling) is a plus
• Fluency in Spanish is a plus
• Experience in home care, health care or senior-related industry is a plus

Title: Chronic Care Management Registered Nurse (Remote)

Location: Remote

Job Description:

Nice to meet you, we’re Vesta Healthcare.

Vesta Healthcare is a specialized medical group focused today on aging adults with long-term home care needs. We help these iniduals live happier, healthier lives by partnering with their aides and caregivers, as a key part of the care team. We use a combination of virtual care, home-based and mobile technologies, data integrations and partnerships with home care agencies to make the home an integrated setting of care with patients, and their Caregivers at the center.

Vesta is the Roman name for the goddess of home, hearth and family. She is the caregiver. Often unseen yet greatly revered, she puts others’ needs ahead of her own, keeping the hearth warm so the home and family can function.

We see Caregivers and recognize the power and potential they embody. More than just assistance, Caregivers are eyes, ears and hands in the home. Caregivers play the role of Doctor, Nurse, Pharmacist, EMT and more, but without support or guidance. That is where Vesta Healthcare comes in. Our program provides Caregivers with a personalized clinical team in their pocket. Our team links Caregivers to the people they care for and the other providers involved in their care. It’s an insurance covered benefit, so it’s available to most adults with Caregivers free of charge to them.

The ideal candidate would be able to:

• • Plan and conduct intervention opportunity evaluations, respond to urgent alerts and remote patient monitoring alerts as needed to help drive high quality care at a lower cost

• • Have the ability and skill to recognize clinical scenarios that require escalation to the internal team nurse practitioner

• • Work directly with the member, via various forms of communication, texting, virtual visits, and telephone, to develop and achieve patient centered chronic care management goals

• • Develop and update care plans for members while keeping a close eye on caregiver and/or family support

• • Apply clinical experience and judgment to the utilization management/care management activities

• • Be responsible for day to day work with patients related to interventions needed for quality outcomes to reduce avoidable admissions, readmissions and ED utilization.

• Collaborate with engagement and product teams to promote quality outcomes, optimize service experience, and promote effective use of resources for complex or elevated medical issues

Would you describe yourself as someone who has:

• • Current RN license in New York OR Illinois (required)

• • Fluency in English AND Spanish in writing, reading, and speaking (required)

• • Graduated from an accredited nursing program (required)

• • At least 2 years of nursing experience providing care to adult and geriatric patient populations (required)

• • Confidence with clinical skills and knowledge of chronic conditions (required)

• • The ability to work remotely and has a private area in their home/workspace (required)

• • A genuine, compassionate desire to serve others and help those in need

• High speed home WiFi/data connection to support company provided IT equipment

In addition to amazing teammates, we also offer:

• • Health, dental, and vision insurance with a choice of many different plans/costs partially subsidized by us

• • Paid vacation

• • Paid Sick/personal days

• • 12 paid holidays

• • One time reimbursement to set up your home office

• • Monthly reimbursement for internet or other home office expenses

• • Monthly gym reimbursement to be used for gyms, online classes, etc

• • Basic Life & AD&D, Short-term and Long-term Disability Benefits paid fully by us

• • Voluntary benefits such as Pet, Home and Auto, Legal Insurance plus more

• • Pre-tax Flex Spending/Dependent Care/Transit accounts

• • 401k plus match

Pay range is $85,000 -$101,000 per year based on experience and location. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level.)

If yes, then we look forward to speaking to you!

Vesta Healthcare is committed to leveraging the talent of a erse workforce to create great opportunities for our business and our people. Vesta Healthcare is an Equal Opportunity/Affirmative Action Employer. Candidates are selected without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.

At Vesta Healthcare, we are constantly searching for the most dynamic and best talent to join our team with a mission of empowering caregivers in the home!

If you are ever contacted by e-mail from any domain other than https://vestahealthcare.com, please do not respond, as there is a likelihood it could be a scam as it is not a legitimate Vesta Healthcare email. You might see things from a similar domain address, but with a slight misspelling, for example. We have no responsibility for any communication that does not come from the https://vestahealthcare.com domain, and we strongly advise that you not provide information or respond if not from the legitimate Vesta Healthcare domain. If you have any concerns that outreach might not be legitimate, please reach out to [email protected] for confirmation.

Title: IRF Patient Assessment Instrument Coder

Location: US

Job Description:

Calling all Inpatient Rehabilitation Facility (IRF) – Patient Assessment Instrument (PAI) Coders!

Exclusive opportunity for an Inpatient Rehabilitation Facility (IRF) – Patient Assessment Instrument (PAI) Coder – KODE is granting company ownership for new hires!

At least one year of professional experience is required- CPC-As are not being considered at this time.

About KODE

We’re coding rebels with a cause. KODE is a health-tech company developed by medical coders for medical coders looking to change the way things are done in the industry. Our company may be young but we’re growing rapidly. That also means we’re not buried in outdated policies and bureaucracies.

Coders play a critical role in healthcare, but have you ever felt like you’re just a cog in the machine? At KODE there are no cogs, there are people. We aren’t looking for a coder to simply fill an open position. We’re looking for a new teammate with a passion for professional coding who wants to join our collective mission to be awesome.

We’re serious about two things: coding and treating you like the professional you are. If this intrigues you, please keep reading.

About this Role

We’re looking for an Inpatient Rehabilitation Facility (IRF) – Patient Assessment Instrument (PAI) Coder to award ownership in our company. Don’t miss your chance to invest in your own success!

Responsibilities:

• Review medical records to assign appropriate ICD-10, CPT, HCPCS codes accurately
• Review physician documentation and perform audits to determine accuracy as needed
• Understand Tier 1, 2, and 3 comorbidities for IRF coding
• Understand the difference between a complication and a comorbidity for IRF coding
• Meet and exceed acceptable productivity & quality standards
• Review tasks and correct codes as needed
• Work collaboratively with coding team to improve coding outcomes
• Perform miscellaneous job-related duties as assigned

Required Qualifications:

• Associate degree in Health Information Management or equivalent
• 3+ years of professional specialty coding experience
• CCS, RHIA, RHIT, CPC by AHIMA or AAPC coding credentials

Additional Skills & Abilities:

• Has working knowledge of coding guidelines
• Ability to use independent judgment to manage and impart confidential information
• Advanced knowledge of medical coding, electronic medical record systems, and coding systems
• Ability to analyze and solve problems
• Strong communication and interpersonal skills
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation
• Knowledge of current and developing issues and trends in medical coding diagnosis and procedure code assignment

The Ideal Candidate:

• Is kind and easy to work with (because mean people s*ck!)
• Sometimes likes to work in their robe (no judgement here)
• Could be into personal and professional growth. (Interested in a project collab with the creative team? Let’s do it! – Do creatives stress you out? They’ll respect your boundaries.)
• Doesn’t send passive aggressive emails and cc others to try to make their coworkers look bad (remember, mean people s*ck!)

What you Get:

• Ownership in the company – unique opportunity to share in KODE’s financial success
• 100% remote WFH (or anywhere) with a flexible work schedule (want to go for a walk at 11am on Tuesday, go for it!)
• Salary is commensurate to your professional experience
• Medical, Dental, Vision, PTO/Holiday Pay
• Life Insurance
• 401(k) w/ company match
• Tech Bundle Welcome Package: Computer, dual monitors, docking station, headset
• KODE swag … Obviously.

What you WON’T Get:

• Micro-managed (gross!)
• Politics & bureaucracy, unnecessary TRAVEL”>TRAVEL”>meetings, and death by PowerPoint
• Forced to turn your video on (we’d love to see your face, but if you aren’t feeling it, NBD)
• One of your coworkers leaving the microwave dirty (we all use our own)
• Boring. Same old, same old. Blah, Blah, Blah.

Title: Senior Coding Specialist

Location: Remote

Job Description:

Are you looking for a career that aligns your passion and values with your purpose? Then we are looking for you!

At Valera Health we are at the forefront of tele-mental health. We are committed to delivering compassionate mental health care that is accessible and affordable to all. To learn more about Valera, check us out HERE.

Watch to learn more about Valera Health here!

Senior Coding Specialist

Primary Purpose: The primary purpose of the Senior Coding Specialist at Valera Health is to ensure the accuracy, completeness, and compliance of medical coding for patient records. This role involves analyzing clinical documentation, assigning appropriate codes for diagnoses and procedures, and collaborating with healthcare providers to optimize coding practices. The Senior Coding Specialist will also provide mentorship to junior coders, contribute to process improvements, and support the organization in maintaining high standards of data integrity and regulatory compliance.

Job Duties:

Perform internal audits as necessary including:

Review patient chart documentation for accuracy, coding compliance, and process adherence.

Conducts complete and timely comprehensive audits with the ability to consistently meet coding standards of 90% accuracy and provide coding and documentation education

Performs pre-and post-billing chart reviews to ensure the clinical documentation provides evidence of compliance with coverage requirements, Valera Health policy, and regulatory requirements including evaluation and management, and treatment rendered by VH providers.

• Ability to research, apply, and keep abreast of all Valera Health policies/procedures, local/state/federal laws/regulations, and serve as a resource to care center locations/isions in these areas.
• Communication and coordination of provider education sessions and written summaries.
• Keep abreast of applicable policies and regulations.
• Administrative – team meetings, attend routine meetings with the Compliance Committee as needed, report findings as necessary, and demonstrate the Company’s Mission, Vision, and Values through both professional behavior and job performance on a day-to-day basis to meet all expectations of the position.
• Communicate with the Compliance/ Security Officer as needed any reportable findings or matters identified during the audit that would put the Company at risk.
• Communicates and informs the care center locations/isions and leadership of audit findings and corrective action plans.
• Prepares accurate, concise, and timely written executive summary of findings and coordinates all provider education sessions.
• Provides feedback to the Compliance Officer and Director of Revenue Cycle Management and other Valera Health departments regarding recommended revisions or updates to Valera policies, education opportunities, and documentation system enhancements.
• Adheres to all Valera’s policies and procedures, the Code of Conduct, the Employee Handbook, the mandatory Ethics and Compliance, and HIPAA privacy and security programs.
  • Associate’s or Bachelor’s degree in Health Information Management, Medical Coding, or a related field preferred but not required.
  • Current certification as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent.Participates in special projects and performs other duties as assigned.

  Qualifications:

Education and Certification or a combination of equivalent experience:

• Associate’s or Bachelor’s degree in Health Information Management, Medical Coding, or a related field preferred but not required.
• Current certification as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent.Experience:
• A minimum of 5 years of coding experience in a healthcare setting, with a focus on mental health services preferred.
• Demonstrated experience in coding complex medical cases and using ICD-10-CM, CPT, and HCPCS coding systems.

Technical Skills:

• Proficient in using electronic health record (EHR) systems and coding software.
• Strong knowledge of coding guidelines, medical terminology, anatomy, and physiology.
• Familiarity with regulatory requirements & compliance standards related to medical coding.

Analytical Skills:

• Ability to interpret and analyze clinical documentation and patient records accurately.
• Detail-oriented with a high level of accuracy in coding and documentation.
• Communication and Interpersonal Skills:

Excellent written and verbal communication skills:

• Ability to work collaboratively with healthcare providers, clinical staff, and administrative teams.
• Strong mentoring and training skills to support the development of junior coding staff.

Physical Demands:

Occasional (0-40%) / Frequent (41-71%) / Constant (72-100%)

• Constant computer work which may require repetitive motion, prolonged periods of sitting, and sustained visual and mental applications and demands.
• Occasional lifting, bending, pulling, collating, and filing, some of which could be heavy (>10 lbs).
• We hire people from all backgrounds because that’s what it takes to build a team that can reach and support those in need of high-quality behavioral healthcare. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.

This job posting/description is intended to convey information essential to understanding the scope of the position. It is not intended to be an exhaustive list of skills, efforts, duties, or responsibilities associated with the positions.

*In compliance with all states and cities that require transparency of pay, the compensation for this position has a guarantee of no less than $58,000.00 to $65,000.00 annually. Note wages may vary based on license level, productivity, experience, location, and skills.

Benefits include but not limited to:

• Health, Vision & Dental Insurance
• 401k through the Standard
• Paid Time Off
• Short Term Disability
• Life Insurance
• Office Equipment
• Many more

Be part of our mission!

We are very proud of the work that we do and it takes a great team to make it happen! If you are interested in one of our open positions, we’d love to start the conversation.

We hire people from all backgrounds because that’s what it takes to build a team that can reach and support those in need of high-quality behavioral healthcare. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Check us out on Linkedin!

Physician Assistant (PA) or Nurse Practitioner (ARNP) – Virtual Care

Remote, USA

Full time

JR19585

You Belong Here.

At MultiCare, we strive to offer a true sense of belonging for all our employees. Across our health care network, you will find a dynamic range of meaningful careers, opportunities for growth, safe workplaces, and flexible schedules. We are connected by our mission – partnering and healing for a healthy future – and dedicated to the health and well-being of the communities we serve.

Join our team as a Nurse Practitioner or Physician Assistant with Indigo. This is a .9 FTE position for our Virtual Clinic.

*** Must reside in or be willing to relocate to Washington or Idaho ***

FTE: .9 = 3 x 12 hour shifts/week Shift: Day, Schedule: TBD

APP Salary Range – .9 FTE Min $126,528.48 – Max $126,528.48

Position Summary

Indigo Health is seeking a Retail (Virtual Health) Nurse Practitioner to join our highly cohesive and innovative team. Providers at Indigo are passionate about modernizing medicine by making it simpler, friendlier, and more accessible for all. They are driven by collaboration, science and delivering a ‘wow’ experience for each patient.

Candidates can expect to work at the top of their license while having opportunities to lead and mentor fellow providers, as desired. We’ve created a better way to work in healthcare that empowers providers with focus, peer support and a 5-star clinical team.

Requirements

• Washington State Nurse Practitioner license by the time of employment
• DEA, NPI & Prescriptive authority
• Current BLS for Healthcare Providers certification by the American Heart Association

Our Values

As a MultiCare employee, we’ll rely on you to reflect our core values of Respect, Integrity, Stewardship, Excellence, Collaboration, Kindness and Joy. Our values serve as our guiding principles and impact every aspect of our organization, including how we provide patient care and what we expect from each other.

Why MultiCare?

• Belonging: We work to create a true sense of belonging for all our caregivers
• Mission-driven: We are dedicated to our mission of partnering for healing and a healthy future and the patients and communities we serve
• Market leadership: Washington state’s largest community-based, locally governed health system
• Employee-centric: Named Forbes “America’s Best Employers by State” in 2023
• Technology: “Most Wired”health caresystem 15 years in a row
• Leading research: MultiCare Institute for Research & Innovation, 40 years of ground-breaking, clinical and health services research in our communities
• Lifestyle: Live and work in the Pacific Northwest – offering breathtaking water, mountains and forest at every turn.

Pay and Benefit Expectations

Intake Registered Nurse

at Twin Health

Remote

Twin Health

At Twin Health, we empower people to reverse, prevent and improve chronic metabolic diseases. Twin Health invented The Whole Body Digital Twin™ , a dynamic representation of each inidual’s unique metabolism, built from thousands of data points collected daily via non-invasive sensors and self-reported preferences. The Whole Body Digital Twin delivers a new standard of care, empowering physicians and patients to make personalized data-driven decisions.

Working here

Our team is passionate, talented, and driven by our purpose to improve the health and happiness of our members. Our culture empowers each Twin to do what’s needed to create impact for our members, partners, and our company, and enjoy their experience at work. Twin Health was awarded Innovator of the Year by Employer Health Innovation Roundtable (EHIR) (out of 358 companies), named to the 2021 CB Insights Digital Health 150, and recognized by Built In’s 2022 Best Places To Work Awards. Twin Health has the backing of leading venture capital funds including ICONIQ Growth, Sequoia, and Sofina, enabling us to scale services in the U.S. and globally and help solve the global chronic metabolic disease health crisis. We have recently announced broad and growing partnerships with premier employers, such as Blackstone and Berkshire Hathaway. We are building the company you always wished you worked for. Join us in revolutionizing healthcare and building the most impactful digital health company in the world!

Excited to join us and do your part in improving people’s health and happiness?

Opportunity

Join us in one of our most critical member-enrollment roles, inspiring behavior change and motivating members to adopt new behaviors and improve their health. Unlike most traditional intake coordination roles, which include evaluating for specific medical services and referrals, the Twin intake RN oversees and guides the clinical enrollment process for members and helps determine placement in the most appropriate member program according to eligibility requirements

As an Intake RN at Twin you make a difference in people’s lives every day by helping members activate in Twin programs, and partnering across care teams.

This job is a great fit for you if you have expertise working with protocols, decision trees, intake or triage are highly motivated, energetic, and focused on enhancing the quality of healthcare. You have demonstrated the ability to work collaboratively with an interdisciplinary care team in the adoption of new technologies to coordinate care, engage in shared decision making, and achieve successful outcomes. You are comfortable leveraging data in observing trends and developing corrective action plans to support the transformation of member lives.

Join Us

This is an exciting role for a Registered Nurse with a erse healthcare systems background. Join us to use your finely-tuned skills in assessing physical and psychological-social needs. You will support a dynamic care team in identifying member goals, health priorities and learning opportunities. This will include utilizing motivational interviewing techniques and designing interventions with members to build engagement and improved health outcomes. Other skill set considerations include ability to work efficiently and with competing priorities, comfort with technology and data, as well as employing knowledge of care management principles.

This role will report to a nurse manager and work within a team pod structure. A successful candidate for this role will be curious, collaborative and adaptable to member journey and team needs. You will be excited to jump into a day that may look a bit different than the day before, while making improvements along the way and building upon your highly-valued skill set.

Responsibilities

• Reviews the member’s medical history, lab results and medications
• Follows intake protocols, established standard processes and clinical assessment decision tree(s)
• Leverages resources to support intake reviews, including the enrollment dashboard, process trackers and assigned tasks
• Works in collaboration with a cross-functional intake team to help support members through the enrollment process
• Demonstrates clinical assessment expertise, may have triage expertise, along with a positive customer service delivery approach with external and internal users
• Utilizes well-developed problem solving and teamwork to accomplish daily outputs

Cross-functional coordination

• Provides initial clinician point of review and escalates to the Twin provider if further assessment for program enrollment is required
• Collaborates closely with team colleagues including nurses, health coaches, providers, and operations teams to drive a seamless experience for members
• Exhibits sound nursing judgment in decisions involved in the coordinating of multiple, complex tasks and communication across team(s)
• Supports communication with members, among the intake team and across the care team, including clinical operations leaders
• Provides timely responses and feedback to colleagues regarding member care

Maintenance of Quality Care

• Serves as a role model, demonstrating effective patient care, leadership, and professional behavior
• Acts as a clinical resource through provision of member enrollment coordination of care, and helps develop and maintain patient care standards, standard processes
• Strictly adheres to Standard Operating Procedures for member management and escalations
• Leverages the nursing processes to triage member alerts and inquiries
• Contributes to the development and improvement of clinical care that enhances cost effectiveness while ensuring quality care
• Participates in on-going education and performance improvement activities

Management of Resources

• Identifies and implements an efficient approach to work that is standardized and enhances productivity
• Documents and updates clinical notes, entries and member communications
• Utilizes and leverages tools to support work (i.e. Text Expanders, data trackers, clinical control centers, systems and platforms, etc.)
• Organizes accurate records and maintains confidentiality according to federal law and Twin policies
• Additional duties as assigned

Qualifications

• Currently active and unencumbered RN license within the state in which patient care is occurring
• Minimum 4 years of nursing experience in various healthcare systems such as hospitals, Federally Qualified Health Care centers, ambulatory care environments (primary care, internal medicine, family practice, surgical/multi-specialty), health payor systems (case management)
• Experience preferred in one or more of the following areas: Triage/intake, case/care management, value-based care, population health, care coordination
• Required, BSN or MSN from accredited school of nursing
• Skilled in motivational interviewing and driving behavior change
• Comfort and enthusiasm for adopting the latest technologies and integrating data and technical outputs in patient care
• Demonstrated ability to manage large caseloads and effectively work in a fast paced environment
• Proficient with simultaneously navigating the internet and multi-tasking with multiple electronic documentation systems and business tools (Google, Slack, etc.)
• Comfort with ambiguity and change
• Experience in a high-growth, or other quickly changing environment
• Professional telephone and video skills
• Self-motivated and results-focused
• Client service excellence
• Quick learner who integrates new knowledge
• Organized and detail-oriented
• Ability to handle competing demands with diplomacy and enthusiasm
• Ability to work collaboratively with clinical infrastructure and hierarchies
• Excellent time management and ability to prioritize work assignments
• Passion for Twin’s purpose to transform lives by empowering people to reverse, prevent and improve chronic metabolic diseases
• Passion for Twin’s purpose to transform lives by empowering people to reverse, prevent and improve chronic metabolic diseases.
• Bilingual, fluent in Spanish preferred

Compensation and Benefits

The compensation range for this position is $80,000-$85,000 annually.

Twin has an ambitious vision to empower people to live healthier and happier lives, and to achieve this purpose, we need the very best people to enhance our cutting-edge technology and medical science, deliver the best possible care, and turn our passion into value for our members, partners and investors. We are committed to delivering an outstanding culture and experience for every Twin employee through a company based on the values of passion, talent, and trust. We offer comprehensive benefits and perks in line with these principles, as well as a high level of flexibility for every Twin

• A competitive compensation package in line with leading technology companies
• A remote and accomplished global team
• Opportunity for equity participation
• Unlimited vacation with manager approval
• 16 weeks of 100% paid parental leave for delivering parents; 8 weeks of 100% paid parental leave for non-delivering parents
• 100% Employer sponsored healthcare, dental, and vision for you, and 80% coverage for your family; Health Savings Account and Flexible Spending Account options
• 401k retirement savings plan

Title: Coding Quality Advisor

Location: Remote – USA

Job Description:

Fathom is on a mission to use AI to understand and structure the world’s medical data, starting by making sense of the terabytes of clinician notes contained within the electronic health records of the world’s largest health systems. Our deep learning engine automates the translation of patient records into the billing codes used for healthcare provider reimbursement, a process today that costs hospitals in the US $15B+ annually and tens of billions more in errors and denied claims. We are a venture-backed company that completed a Series B round of financing for $46M in late 2022.

We are seeking a Coding Quality Advisor to contribute to Fathom’s next stage of growth. This role is an excellent opportunity for a talented, entrepreneurial strategist and operator to bring a consulting toolkit, a working knowledge of medical coding or revenue cycle management, and a drive to transform healthcare to a high-growth technology firm. This is a cross-functional role working across disciplines including product, sales, finance, operations, and engineering. This role requires prior professional hands-on experience with medical coding and auditing. If this opportunity speaks to you, we want to hear from you!

Please note that this position requires physical residency in the U.S.

Your role and responsibilities:

• Working with clients to establish and maintain medical coding accuracy thresholds
• Developing and enhancing internal and client-facing analytics and reporting
• Reviewing and auditing medical records and physician documentation for diagnosis and procedure code accuracy
• Conducting strategic analysis and scenario modelling across functional disciplines
• Preparing executive presentations and reports for internal and external audiences
• Tracking, aggregating and summarizing coding and billing rules for the product team
• Collaborating with engineering and product teams on features and roadmap
• Providing coding education and training to internal engineering and product teams

We are looking for a teammate with:

• Current AAPC or AHIMA certification(s) and medical coding/auditing outpatient experience in a professional setting
• Prior experience working in healthcare, especially healthcare consulting
• Experience working with medical coding guidelines and documentation requirements
• Working knowledge of anatomy/physiology, disease process and medical terminology
• Familiarity with medications and reimbursement guidelines
• A proven ability to communicate effectively across domains and experience levels
• Drive to innovate, identify novel approaches, and act decisively
• Fluency in productivity tools like Microsoft (Excel, Powerpoint) and Google Suite (Sheets, Docs, etc.)

Bonus points if you have the following experiences:

• Coding compliance consulting and/or coding litigation consulting
• Revenue cycle management
• External vendor management
• Coding for a broad array of outpatient specialties
• Inpatient coding, risk adjusted coding, and/or medical coding training
• Clinical documentation improvement
• Prior work in an entrepreneurial environment
• Prior work in client-facing and/or project management roles
• An MBA degree or equivalent experience

Compensation:

• Salary: $100,000 USD – $160,000 USD
• Company Equity

Benefits:

• PTO and Uncapped Sick Days
  Medical/Dental/Vision Coverage
• 401k Matching
• $1,500 USD Home Office Budget
• Virtual and Local Office (San Francisco, New York City and Toronto) Team Building Events
• Annual Company TRAVEL”>Off-site

Title: Inpatient Care Management Nurse RN – Remote

Location: East Providence RI US

Job Description:

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by ersity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

There’s an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you’ll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.

As an Inpatient Care Management Nurse, you will be responsible for ensuring proper utilization of our health services. This means you will be tasked with assessing and interpreting member needs and identifying solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization.

What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you’ll open doors for yourself that simply do not exist in any other organization, anywhere.

Work hours will be Monday to Friday 8:00 AM – 5:00 PM in business time zone.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges

Primary Responsibilities:

• • Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (InterQual criteria)

• • Discuss cases with facility healthcare professionals to obtain plans-of-care

• • Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management

• • Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level

• • Consult with the Medical Director, as needed, for complex cases and make appropriate referrals to downstream partners

• • Apply clinical expertise when discussing case with internal and external Case Managers and Physicians

• • Identify delays in care or services and manage with MD

• • Follow all Standard Operating Procedures in end to end management of cases

• • Facilitate timely and appropriate care and effective discharge planning

• • Participate in team TRAVEL”>TRAVEL”>meetings, education, discussions, and related activities

• • Maintain compliance with Federal, State and accreditation organizations

• • Identify opportunities for improved communication or processes

• Participate in audit activities and TRAVEL”>TRAVEL”>meetings

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• • Current, unrestricted RN license in the state of residence

• • 3+ years of acute care clinical nursing experience

• • 1+ years of utilization review experience using evidence-based guidelines

• • Demonstrate a proficiency in computer skills – Windows, Teams, Excel (Microsoft Suite), Outlook, clinical platforms

• Designated workspace and access to install secure high-speed internet via cable / DSL in home

Preferred Qualifications:

• • Bachelor’s degree/ BSN

• • Compact license

• • Managed Care experience

• Experience performing discharge planning

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for this role is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

DRG/IBR Nursing Auditor

locations

Remote USA

time type

Full time

job requisition id

R2016

At Devoted Health, were on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. Thats why were gathering smart, erse, and big-hearted people to create a new kind of all-in-one healthcare company one that combines compassion, health insurance, clinical care, service, and technology–to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we’ve grown fast and now serve members across the United States. And we’ve just started. So join us on this mission!

Job Description

A bit about this role:

• At Devoted, we know that one of the most important ways we will build trust is by ensuring we pay claims accurately and on time.
• We also have a fiduciary responsibility to protect the Medicare Fund and this role will play an integral part in doing that.
• The DRG/IBR Nursing Auditor performs inpatient reviews by validating accuracy of the DRG code assignment completeness, POA, discharge status, etc. to ensure accurate payment to our providers.
• The DRG/IBR Nursing Auditor determines if a discrepancy exists in the coding and clinical documentation using standard documentation guidelines applicable to the program.
• This Work-from-Home position will primarily perform desk audits, validate vendor identification, and perform dispute reviews.

Your responsibilities and impact will include:

• Conduct initial audit reviews to validate billed diagnoses and DRG code are supported by medical records.
• Conduct initial IBR reviews for billing accuracy.
• Record Audit results and document finding notes based on policies using professional clinical resources.
• Perform provider appeals reviews and render coding decision to either uphold or overturn original finding.
• Review questionable encoder results, complex cases and appeal reviews with program manager, and facilitate referrals to clinical department as needed.
• Propose new audit concepts supported by your research and analysis.
• Define new audit concept criteria and test and validate new concepts developed by analytics team.

Required skills and experience:

• Associate or Bachelor’s degree in Nursing (active / unrestricted license)
• Understanding of the medicare DRG payment methodology
• 2-3 years of Claims auditing experience
• Strong verbal and written communication skills
• Understanding of CMS guidelines related to Medicare Advantage claims

Desired skills and experience:

• CCS, CPC, or RHIA (preferred)
• 3-5 years of inpatient hospital coding experience with ICD 10 CM/PCS, MS-DRG

Salary range: $54,000 – $91,000 / year

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the inidual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more….

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoteds mission to treat our members like family. We are committed to a erse and vibrant workforce.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value ersity and collaboration. Iniduals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoteds Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

Hospital Coding Quality Specialist – REMOTE

locations

Remote

time type

Full time

job requisition id

R115759

Department:

10393 Revenue Cycle – Coding & HIM Support Facility/HIM

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

This is a REMOTE opportunity.

Responsible for completing hospital coding accuracy reviews to assist coding leadership in carrying out the department’s compliance plan to ensure that our coding team members are coding accurately according to the documentation within each record, validating accurate external reporting and appropriate reimbursement.

Reviews coded health information records to evaluate the quality of staff coding and abstracting, verifying accuracy and appropriateness of assigned diagnostic and procedure codes, as well as other abstracted data, such as discharge disposition. Ensure accurate coding for outpatient, day surgery and inpatient records. Verifies all codes and sequencing for claims according to American Hospital Association (AHA) coding guidelines, CPT Assistant, AHA Coding Clinic and national and local coverage decisions.

Works collaboratively with coding leadership per their direction in reviewing records with focused diagnosis and procedure codes, including specific APCs, DRGs and OIG work plan targets to assure compliance in all areas of coding, which may give visibility into documentation that is driving codes.

Works collaboratively with coding leadership to identify focused prospective records that need to be reviewed.

Identifies coder education opportunities, team trends, and consideration of topics to mandate for second level account review, before the account is final coded.

Reviews encounters flagged for second level review, including but not limited to; hospital acquired conditions (HACs), complications and other identified records such as core measures or trends as identified by coding leadership. Perform review of coded encounter for appropriate risk-adjustment, including accurate severity and risk of mortality assignment.

Responsible for coding participation in the Clinical Documentation Improvement and Hospital Coding alignment process. Review accounts with mismatched DRG assignment following notification from the Inpatient coder. Determine the appropriate DRG based on coding guidelines. Provide follow up to the clinical documentation nurse with rationale on final outcome. Recommends educational topics for coders and clinical documentation nurses based on their observations from reviewing mismatches.

Participate in hospital coding denial and appeal processes as directed. Ensure timely review and response to any third-party payer notification of claims where codes are denied. Determine if an appeal will be written based on application of coding guidelines and provider documentation.

Following review of overpayment or underpayment denials, provide appropriate follow-up to coding team member as appropriate, rebilling accounts to ensure appropriate reimbursement. All trends identified should be presented to coding leadership in a timely manner and logged for historical tracking purposes.

Investigates and resolves all edits or inquiries from the billing office or patient accounts, to prevent any delay in claim submission due to open questions related to coding. Identifies any coding issues as they relate to coding practices. Clarifies changes in coding guidance or coding educational materials.

Maintains continuing education credits and credentials by keeping abreast of current knowledge trends, legislative issues and/or technology in Health Information Management through internal and external seminars. Identify opportunities for continuing education for hospital coding team.

Licenses & Certifications

• Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA), or
• Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or
• Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), or

Degrees

• Associate’s Degree in Health Information Management or related field.

Required Functional Experience

• Typically requires 5 years of experience in hospital coding for a large complex health care system, which includes hospital coding, denial review and/or coding quality review functions.

Knowledge, Skills & Abilities

• Demonstrated leadership skills and abilities.
• Demonstrates knowledge of National Council on Compensation Insurance, Inc. (NCCI) edits, and local and national coverage decisions.
• Expert knowledge and experience in ICD-10-CM/PCS and CPT coding systems, G-codes, HCPCS codes, Current Procedural Terminology (CPT), modifiers, and Ambulatory Patient Categories (APC), MS-DRGs (Diagnosis related groups).
• Advanced knowledge in Microsoft Applications, including but not limited to; Excel, Word, PowerPoint, Teams.
• Advanced knowledge and understanding of anatomy and physiology, medical terminology, pathophysiology (disease process, surgical terminology and pharmacology.)
• Advanced knowledge of pharmacology indications for drug usage and related adverse reactions.
• Expert knowledge of coding work flow and optimization of technology including how to navigate in the electronic health information record and in health information management and billing systems.
• Excellent communication and reading comprehension skills.
• Demonstrated analytical aptitude, with a high attention to detail and accuracy.
• Ability to take initiative and work collaboratively with others.
• Experience with remote work force operations required.
• Strong sense of ethics.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

Title: Facility Credentialing Specialist III – REMOTE

Location: USA

Job Description:

Overview

US Anesthesia Partners (USAP) is currently seeking a Credentialing Coordinator to join our team, remotely. Maintains accurate records of providers’ credentials. Processes providers’ applications for privileges and reappointments and monitors licensure renewal activity for Physicians, CRNA’s, APN’s, and PA’s.

Job Highlights

ESSENTIAL DUTIES AND RESPONSIBILITIES (include but not limited to):

• Processes initial applications and reappointments for hospitals, surgical centers and managed care entities for assigned isions.
• Maintains complete file of provider’s licensure and credentials. Monitors renewals of licensure and forwards copies of licensure to facilities as renewals are received.
• Maintains and updates credentialing database, inclusive of demographic and licensure information.
• Maintains and updates continuing medical education/ACLS credits and other training requirements.
• Maintains and updates curriculum vitae/profiles for each provider.
• Maintains correspondence files and credentialing archival files.
• Performs other credentialing duties as requested.
• Adhere to all company policies and procedures.
• Perform other duties as assigned.

Qualifications

JOB REQUIREMENTS (Knowledge, Skills and Abilities):

• Knowledge of organization’s policies, procedures and systems.
• Skilled in computer applications including MS Word, MS Excel, database administration and scanning applications.
• Knowledge of NCQA and/or JCAHO Accreditation standards.
• Skilled in verbal and written communications.
• Knowledgeable in Federal and State Regulation on Confidentiality; and Peer Review Guidelines.
• Ability to work effectively with staff, physicians and external customers.
• Ability to work independently with limited supervision.
• Communicate well with the public

EDUCATION/TRAINING/EXPERIENCE:

• High School graduate or equivalent. A.S. or B.S. degree in business administration or health care related field preferred.
• CPMSC/CPCS Certification preferred.
• Five years minimum experience in Credentialing

US Anesthesia Partners, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, disability (physical or mental), family medical history or genetic information, political affiliation, military service, or other non-merit based factors.

Job ID2024-14872

FunctionRevenue Cycle Management

LocationUS-Remote

Employment StatusFull Time

Title: Inpatient Clinical Dietitian PRN

Fully Remote

locations Intermountain Medical Center

time type Part time

job requisition id R109280

Job Description:

Facilitates the nutrition care process in order to provide the patient with optimal medical nutrition therapy.

Posting Details

• $1250 Sign on Bonus
• Shift: 8am-4:30p with some flexibility. Rotating weekends/holidays
• 100% Remote. However, we are unable to consider candidates for remote opportunities in the following states: California, Hawaii, Rhode Island and Washington.
• PRN- As needed
• Bilingual is a plus. Experience with computers, excel, Microsoft teams strongly preferred

Job Essentials

• Completes and documents nutrition assessment.
• Completes and documents nutrition diagnosis.
• Identifies and implements appropriate nutrition interventions including quality nutrition education based on customer needs, expectations, and culture.
• Monitors and evaluates inidual nutrition outcomes related to nutrition diagnosis, goals, and interventions.
• Communicates nutrition expertise with all appropriate healthcare providers.
• Uses resources effectively and efficiently in practice.
• Precepts students.
• Participates in department continuous improvement projects.
• Collaborates with other dietitians as needed.

Note: If employee is hired without being a Registered Dietitian, they must successfully pass the RD exam with six months of hire to remain in the job. If employee is hired without being a Certified Dietitian, they must become also become certified within six months of hire to remain in the job.

Minimum Qualifications

• Bachelors in dietetics, nutrition, or nutrition related field. Degree must be obtained through an accredited institution. Education is verified.
• Successful completion of an approved Academy of Nutrition and Dietetics (AND) program
• Registered with the Commission on Dietetic Registration or registration eligible (see note above)
• Self starter, detail oriented, and effective organizational skills
• Demonstrated computer proficiency
• Certified Dietitian in the state of Utah or obtain within six months of hire (see note above)
• For caregivers that handle food as part of their responsibilities (i.e.: cooking demos or assist with meal delivery), a Food Handler’s Permit (as required by facility)

Preferred Qualifications

• One year experience as a registered dietitian

Physical Requirements:

• Interact with others requiring the employee to communicate information.
• Operate computers and other equipment requiring the ability to move fingers and hands.
• See and read computer monitors and documents.
• Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Location:

Intermountain Medical Center

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

0

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$25.08 – $38.71

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers, and for our Colorado, Montana, and Kansas based caregivers; and our commitment to ersity, equity, and inclusion.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Full Time Staff General Medicine Nurse Practitioner

locations

Remote – USA

time type

Full time

Empowering Minds, Transforming Lives!

Do you want to be a part of one of the most innovative healthcare experiences in the world? Do you enjoy building a better world through connections? If you answered yes to both, Teladoc Health Medical Group may be the right place for you!

As an employed Staff Clinician at Teladoc Health, you will be in the centerfold of progressive thinking, empowerment, and cultivating connections. Our Full Time Employed clinicians provide evidence-based treatment via telephone or video. Teamwork is especially important to us at Teladoc Health, and each clinician works with a practice manager, clinical director, and has access to resources and support. Must be able to work in an unsupervised capacity.

Summary of Position

As a Full-time Nurse Practitioner at Teladoc Health, you will be in the centerfold of progressive thinking, empowerment, and cultivating connections. Our full-time remote Nurse Practitioners provide urgent care treatment to patients via telephone or video. Teamwork is very important to us at Teladoc Health, and each Provider works with a Practice Manager, Medical Director, and has access to resources and support. Must have the ability to work in a fully unsupervised capacity.

Essential Duties and Responsibilities

• Conduct virtual patient assessments, including collecting medical history, performing physical examinations, and diagnosing and treating common urgent care illnesses and injuries.
• Develop and implement treatment plans in collaboration with patients, providing education and counseling on health promotion and disease prevention.
• Order and interpret diagnostic tests, such as laboratory work, to aid in diagnosis and treatment decisions.
• Prescribe appropriate medications and therapies, adhering to evidence-based guidelines and considering patient preferences and limitations.
• Provide patient education and support, including answering questions, addressing concerns, and promoting healthy lifestyle choices.
• Collaborate with interdisciplinary healthcare teams, including physicians, specialists, and other healthcare professionals, to ensure coordinated and comprehensive care.
• Maintain accurate and up-to-date electronic health records (EHR) for all patient encounters.
• Stay current with advancements in healthcare technology, telemedicine practices, and relevant professional guidelines and standards.
• Participate in quality improvement initiatives and contribute to the development of best practices in virtual care.

Qualifications Expected for Position

• Ability to work independently and efficiently in a virtual setting, demonstrating strong clinical judgment and decision-making skills.
• Excellent communication skills, both verbal and written, with the ability to effectively interact with patients and interdisciplinary teams remotely.
• Proficiency in using telehealth platforms and electronic health records (EHR) systems.
• Strong commitment to patient-centered care, empathy, and cultural sensitivity.
• Ability to adapt to rapidly evolving virtual care practices and embrace innovative technologies.
• Dedication to ongoing professional development and lifelong learning.

The above qualifications, knowledge, experience, and/or background are expected but not required for this role.

Required license or credential needed to perform job:

• Advanced Practice Registered Nurse with either a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP)
• Board Certification by ANCC or AANP
• Valid Nurse Practitioner license in a Non-Collaboritive state
• No disciplinary actions within the last 5 years
• Minimum of 5 years of post-graduate clinical experience as a Nurse Practitioner, in primary care, family practice, emergency medicine or urgent care.

Physical Requirements

To perform this job successfully, an inidual must be able to perform each essential job duty satisfactorily. Reasonable accommodations may be made to enable qualified iniduals with disabilities to perform essential job functions. Teladoc Health will make reasonable accommodations for the known physical or mental limitations of an otherwise qualified inidual in line with company policy.

Why join Teladoc Health?

Staff Clinicians are offered a competitive compensation package and annual performance bonus.

We Provide you with work equipment as a full-time clinician.

Annual Benefit Offer:

• 192 PTO (Paid Time Off) hours, 80 Safe, Sick and Caregiver Hours.
• 401k, match up to 4% after 1 year of employment.
• Malpractice coverage.
• Full panel of medical benefits.
• Access to Teladoc Virtual Care for you and your dependents.
• Yearly CE (Continuing Education) Credit.

Scheduling: Full-time clinicians will have the option to choose from 3 scheduling templates that fit their work/life balance.

Ranked #1 among direct-to-consumer telehealth providers in the J.D. Power 2021 U.S (United States). Telehealth Satisfaction Study.

Growth and Innovation: Teladoc Health is the largest and oldest telehealth company since 2002. We have already made healthcare yet remain on the threshold of very big things. Come grow with us and support our mission to make a tangible difference in the lives of our members.

Diversity and Inclusion: At Teladoc Health we believe that personal and professional ersity is the key to innovation. We hire based solely on your strengths and qualifications and how they can directly contribute to your success in your new position.

Focus on PEOPLE: Teladoc Health has been recognized as a top employer by numerous media and professional organizations. Talented, passionate iniduals make the difference, in this fast-moving, collaborative, and inspiring environment.

Hospital Coding & Compliance Specialist

Company Craneware Inc

Speciality Data Operations

Category Permanent

Location Country

Office LocationHome based – US

Additional Locations

Introduction to Craneware

Let’s transform the business of healthcare! At The Craneware Group, we are dedicated to empowering our customers with industry-defining insights that pave the way for a brighter future.

If you are an energetic, forward-thinking inidual with a passion for innovation, we invite you to join our thriving team of more than 750 dedicated professionals. Together, we’ll fuel the expansion of our SaaS platform and develop cutting-edge applications that redefine the healthcare landscape.

The Team

In this role you will be responsible for the maintenance and quality analysis of hospital-focused regulatory data used within Craneware products along with providing customer facing support & education.

You Will Be

• Research, interpret & update facility billing and compliance logic which is of a complex nature through the use internal tools or software products such that Craneware products and services are up to date and accurate.
• Work with other Data Revenue Advisors and Director of Revenue Data Advisory to define new and current logic for products and analysis.
• Acquire, receive, and track receipt of multiple data files from CMS, the AMA, and other regulatory bodies to determine its use within internal tools and software products, to ensure the products and services provided to customers are up to date and accurate.
• Manage customer expectations and service level agreements/timelines, ensuring that customers are kept up to date on all coding, billing, and compliance regulations.
• Maintain all departmental processes and procedures to detail the functions and data requirements of the products and company, to ensure accurate recording of processes and procedures.
• Continuously monitor facility-based billing technical, industry and business trends and take responsibility for personal development, to ensure that the future needs of the company are met.
• Perform QA for Revenue Data Analyst and other Revenue Data Advisory. Track and report productivity and QA of team.
• Work on complex QA projects.
• Provide customer facing support and responses to facility-based billing queries.
• Provide market facing educational sessions on complex regulatory material as required.
• Present at industry events (e.g. Summit, ANI, HFMA).

You Will Bring

• Educated to Bachelor‘s degree level
• 10+ years’ experience working in a hospital-based healthcare related field specific to revenue cycle, coding and/or reimbursement
• Deep knowledge of Medicare OPPS and IPPS coding & reimbursement methodologies
• Coding Certification or 15 years in a specific areas of regulatory data
• Broad knowledge in multiple area of healthcare regulatory arena– Reimbursement, OPPS, IPPS, ASC, Physician, etc.
• Microsoft Office – ability at intermediate level
• Intermediate Level of Project management skills
• High Level of communication skills both written and verbal
• Ability to self-plan and self-organize effectively and use appropriate tools for planning purposes
• Proven track record of accuracy and thoroughness
• Deep product knowledge of any specific Craneware products that are supported as well as general knowledge of any secondary product where data overlaps.
• Intermediate experience with Public Speaking

Virtual Diabetes Nurse Clinician Manager

Location

Remote

Type

Full time

Department

Science & Medicine Clinical Care

Compensation

• Estimated base salary $87K – $96K

Overview

Virta is an online specialty medical clinic that reverses type 2 diabetes, pre-diabetes, and obesity safely and sustainably without the risks, costs, or side effects of medications or surgery. Our innovations in the application of nutritional biochemistry, data science, and digital tools–combined with our clinical expertise–are shifting the diabetes treatment paradigm from management to reversal.

Virta has developed a novel, team-based care model that delivers the Virta treatment exclusively through a telemedicine platform, with no brick-and-mortar clinics. Our clinical trial, which has already produced six peer-reviewed publications, shows that the Virta treatment has lowered hemoglobin A1c values under the diabetes threshold while discontinuing diabetes medications.

The American Diabetes Association has endorsed the core component of the Virta treatment, personalized carbohydrate restriction, as a first-line nutritional therapy for people with type 2 diabetes.

We’ve been reversing diabetes for the last seven years, we see patients in all 50 states, and we are expanding our reach to patients with pre-diabetes and obesity. Our mission: Reverse type 2 diabetes in 100 million people.

To achieve that mission, Virta is looking for an experienced leader to help build and manage this new Team of RN CDE’s as a player-coach.

Calling out two key requirements of the role:

1. You must hold an active RN license in a Nursing Compact state.
2. In your application you must demonstrate that as a manager, you have helped your direct reports improve their skills and develop their careers, hired for quality and counseled people out, and built team cohesion and rapport.

Responsibilities:

• Build and manage a team of 10-15 outstanding part-time nurses, including managing QA/QI, supervision, scheduling, and working with our administrative team to manage licensure of team members.
• Be a player coach: spend approximately half your time seeing patients and half your time managing the team.
• Conduct 20-minute clinical intake visits with prospective patients via video and/or phone. Intakes include verifying and documenting a clinical history, verifying medications, answering basic questions about Virta treatment, and identifying and flagging concerning history or labs for provider review.
• Educate patients about Virta and Virta’s treatment and helping them prepare for their nutritional and behavioral journey with Virta, setting them up for clinical success.
• Management activities will include, but are not limited to:
  • Daily Schedule hygiene for assigned nursing team to enhance applicant throughput.
  • Monitoring and assigning provider support requests and initiatives.
  • Providing updates to clinical intake workflow
  • Delivery of just in time feedback as needed
  • Weekly POD TRAVEL”>meeting with team
  • Working with Head of Nursing and Clinical leads on developing

and implementing quality initiatives.

• Commitment to providing care of the highest quality that delivers an exceptional experience for the patient

Requirements

• Minimum of 2 experience working with diabetes patients in a clinical setting
• Interest and knowledge of diabetes care, diabetes prevention, and low carbohydrate nutrition.
• 3+ years experience managing nurses ideally in an ambulatory, virtual practice, or in a clinical diabetes setting.
• Active RN license with at least one year of clinical experience working with patients with type 2 diabetes. CDE licensure preferred but not required
• Active RN license in, and resident of, a Nursing Licensure Compact state
• Associate or Bachelor’s RN Nursing degree from an accredited school or university
• Eligible for licensure in every U.S. state.
• Interest and aptitude for working with a growth stage, tech-enabled healthcare organization
• Occasional (2-3x/yr) travel to team and company events.
• An outstanding bedside manner: patients trust you and feel supported and empowered by your presence on the phone/video and your communication.
• Team player: You work well with others, put your team first, and contribute toward the betterment of the Virta clinical team.

On Our Values-Driven Culture:

Virta’s company values drive our culture, so you’ll excel if:

• You put people first and take care of yourself, your peers, and our patients equally.
• You take initiative and complete tasks conscientiously while empowering others to do the same.
• You value positive impact over busy work.
• You can check your ego and recognize that everyone has something to bring to the table.
• You take risks and iterate rapidly.
• You promote transparency, trust, and empowerment through open access of information.
• You prioritize data and science over seniority and dogma.

As part of your duties at Virta, you may come in contact with sensitive patient information that is governed by HIPAA. Throughout your career at Virta, you will be expected to follow Virta’s security and privacy procedures to ensure our patients’ information remains strictly confidential. Security and privacy training will be provided.

#LI-remote

Virta has a location based compensation structure. Starting pay will be based on a number of factors and commensurate with qualifications & experience. For this role, the compensation range is $87,000 – 96,000.

Title: Bilingual Transitional Care Management Registered Nurse (Remote)

Location: Remote

Job Description:

Nice to meet you, we’re Vesta Healthcare.

Vesta Healthcare is a specialized medical group focused today on aging adults with long-term home care needs. We help these iniduals live happier, healthier lives by partnering with their aides and caregivers, as a key part of the care team. We use a combination of virtual care, home-based and mobile technologies, data integrations and partnerships with home care agencies to make the home an integrated setting of care with patients, and their Caregivers at the center.

Vesta is the Roman name for the goddess of home, hearth and family. She is the caregiver. Often unseen yet greatly revered, she puts others’ needs ahead of her own, keeping the hearth warm so the home and family can function.

We see Caregivers and recognize the power and potential they embody. More than just assistance, Caregivers are eyes, ears and hands in the home. Caregivers play the role of Doctor, Nurse, Pharmacist, EMT and more, but without support or guidance. That is where Vesta Healthcare comes in. Our program provides Caregivers with a personalized clinical team in their pocket. Our team links Caregivers to the people they care for and the other providers involved in their care. It’s an insurance covered benefit, so it’s available to most adults with Caregivers free of charge to them.

The ideal teammate would be an RN who is passionate about advocating for their patients. Someone who will ensure our members have a safe transition between a healthcare facility and their home. They understand the hardships patients and their caregivers can encounter during transitions of care events and have the clinical skills and ability to catch onto warning signs of acute symptoms/exacerbations of certain chronic conditions and escalate as needed.

The ideal teammate would be able to:

Would you describe yourself as someone who has:

• • Support patients and their caregivers during transitions of care events by serving as their advocate and resource.

• • Conduct assessments to identify expected patient needs for discharge, and coordinate meeting those needs with their provider team in a timely manner.

• • Evaluate the patient’s understanding of their discharge care instructions and their chronic health conditions, providing education and support as needed for effective self-management.

• • Coordinate routine check-ins with patients and their caregivers during their first 30 days post-discharge to identify care plan barriers and provide early interventions to mitigate preventable readmissions.

• • Provide ongoing reassessment and determine the need for escalation as needed to improve patient outcomes.

• Navigate various platforms for documentation and retrieval of member information.

• • Available to work Monday – Friday, 9:00 am – 6:00 pm EST (required)

• • Has an active Registered Nurse license in the state of New York AND a Massachusetts or Compact license (required)

• • Is bilingual and fluent in both English and Spanish (required)

• • Graduated from an accredited nursing program (required)

• • 1+ years of experience as a Transitional Care Manager RN in an outpatient setting (not a hospital setting) (required)

• • 2+ years of nursing assessment experience in an acute setting (required)

• • The ability to work remotely and has a private area in their home/workspace (required)

• • A genuine, compassionate desire to serve others and help those in need

• • High speed home WiFi/data connection to support company provided IT equipment

• In addition to amazing teammates, we also offer:

• • Health, dental, and vision insurance with a choice of many different plans/costs partially subsidized by us

• • Paid vacation

• • Paid Sick/personal days

• • 12 paid holidays

• • One time reimbursement to set up your home office

• • Monthly reimbursement for internet or other home office expenses

• • Monthly gym reimbursement to be used for gyms membership and classes

• • Basic Life & AD&D, Short-term and Long-term Disability Benefits paid fully by us

• • Voluntary benefits such as Pet, Home and Auto, Legal Insurance plus more

• • Pre-tax Flex Spending/Dependent Care/Transit accounts

• • 401k with a match

• • Pay range is $85,000-$101,000 based on experience. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).

If yes, then we look forward to speaking with you!

Vesta Healthcare is committed to leveraging the talent of a erse workforce to create great opportunities for our business and our people. Vesta Healthcare is an Equal Opportunity/Affirmative Action Employer. Candidates are selected without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.

At Vesta Healthcare, we are constantly searching for the most dynamic and best talent to join our team with a mission of empowering caregivers in the home!

If you are ever contacted by e-mail from any domain other than https://vestahealthcare.com, please do not respond, as there is a likelihood it could be a scam as it is not a legitimate Vesta Healthcare email. You might see things from a similar domain address, but with a slight misspelling, for example. We have no responsibility for any communication that does not come from the https://vestahealthcare.com domain, and we strongly advise that you not provide information or respond if not from the legitimate Vesta Healthcare domain. If you have any concerns that outreach might not be legitimate, please reach out to [email protected] for confirmation.

Coding Educator

Location:Nationwide

Location Type: Remote

Schedule:Full_time

Req:R-340835

About this job

Become a part of our caring community and help us put health first

The Coding Educator 2 identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. The Coding Educator 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Coding Educator 2 reviews medical records and arranges educational sessions with providers aimed at quality of care and documentation improvements. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Use your skills to make an impact

Required Qualifications

• AAPC or AHIMA Coding Certification
• 2 + yrs recent medical record review knowledge
• Comprehensive knowledge of MS Word, Excel and PowerPoint
• Adobe Acrobat working experience required
• Presentation skills to include public speaking and interacting with Providers
• Problem solve complex issues
• Guide business and leadership in process improvement
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Must have a separate room with a locked door that can be used as a home office, to ensure you and your patients have absolute and continuous privacy while you work.

Preferred Qualifications

• Bachelor’s Degree (equivalent work and educationexperience)
• Bilingual

Additional Information

To ensure Home or Hybrid Home/Office associates ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

#LI-KR1

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and inidual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$57,700 $79,500 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or inidual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, Humana) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, iniduals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Title: Nurse Practitioner – Urgent Care (Part-Time)

Location: Remote

Type: Part-time

Workplace: remote

Category: Clinical Team

Job Description:

We are seeking a highly motivated nurse practitioner who enjoys management of all health conditions and who is passionate about raising the standard of healthcare for everyone. The Nurse Practitioner will be responsible for caring for patients, maintaining accurate and current patient records, and working collaboratively with our provider and support teams. Start a conversation with us and learn how you can positively impact the lives of patients and play a role in improving healthcare. Currently unable to consider: * Candidates residing in the following states: AL, GA, MS, MO, OK, SC, TN

Responsibilities:

• Function autonomously to perform age-appropriate history and virtual examinations, evaluate, diagnose, recommend treatment plan and document findings appropriately and timely
• Deliver high quality patient care while maintaining safety
• Document medical information of patients and review patient history at each visit
• Request consultation or referral with other health care providers when appropriate
• Counsel and educate patients
• Order and interpret diagnostic tests as needed
• Evaluate, triage and manage pediatric and adult patients for both acute, chronic and mental health conditions
• Actively maintain knowledge of current medical research and trends
• Provide administrative support or cross-coverage for reviewing laboratory test results
• Scheduling flexibility to include evenings and weekends

Required Qualifications:

• Current and active Advanced Practice Registered Nurse (APRN) licensure
• Board certified – Current national certification as a Family Nurse Practitioner through AANp or ANCC
• Licensed Nurse Practitioner who also maintains an active RN license
• Ability to obtain both RN and NP licensure in additional states
• Graduate of an accredited school of nursing
• Graduate of Master’s Degree level accredited Family Nurse Practitioner Program
• 3+ years of clinical experience as a Nurse Practitioner in primary care (preferred) or urgent care required
• Experience/Comfortable with providing care for all ages, newborn to adult populations
• Ability to function within an integrated medical practice
• Outstanding clinical expertise
• Excellent communication and interpersonal skills
• Comfortable with technology
• Demonstrate flexibility

Preferred Qualifications:

• Multistate licensure preferred
• Telemedicine or virtual care experience preferred
• Experience with Athena EMR preferred

Part-Time Shift and Scheduling Obligations:

• A minimum of 20 clinical shift hours per week/40 hours per pay period
• Weekday evening shifts scheduled between the hours of 4p-11p in clinician’s time zone
• Every other weekend, Saturday and Sunday shifts, 8 hours/day, scheduled between 7a-11p in the clinician’s time zone – rotating between day/evening shifts every other weekend
• 2 holiday shifts per calendar year

Physical/Cognitive Requirements:

• Prompt and regular attendance at assigned work location (virtually).
• Ability to remain seated in a stationary position for prolonged periods.
• Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment.
• No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required.
• Ability to interact with leadership, employees, and members in an appropriate manner.

The duties and responsibilities in this job description are neither exclusive nor exhaustive and will be updated on a regular basis and may be amended in the light of changing circumstances or business needs. While this job description is intended to be an accurate reflection of the current job, Included Health reserves the right to add, modify, or exclude any duty or requirement at any time or without any notice. Finally, this job description is not intended in any way to create a contract of employment. Unless you have a written employment agreement signed by an authorized Included Health or Doctor On Demand representative, you are employed at-will. The United States compensation for this independent contractor position is $15 per visit. In addition to receiving a competitive pay, the compensation package may include the following: – 401(k) savings plan through Fidelity – Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependents. Your recruiter will share more about the compensation for this role during the hiring process. #LI-Remote #LI-SK1 About Included Health Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community – no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more atincludedhealth.com. —– Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance.

Title: Medical Records Coder – Remote – Cigna Healthcare

Location: CT-Bloomfield; US Remote

Job Description:

Job Summary:

The primary function of this position is to perform ICD-10-CM coding for reimbursement through documentation review. The employee reviews, analyzes, and codes as supported by documentation. Ensure codes are accurate and sequenced correctly in accordance with government and insurance regulations.

Job Summary:

Responsible for assigning ICD-10-CM codes to documentation received from provider offices. May conduct remote chart reviews (extracting ICD-10-CM codes and ICD-10-CM from medical records) and assign ICD-10-CM codes to documentation received for comprehensive review. Identifies providers that may need additional education on ICD-10- coding, documentation requirements, or training. Maintain 95% coding accuracy rate along with daily production.

Minimum Requirements:

• At least one year of coding experience.
• Some type of coding certification, which may include Certified Professional Coder (CPC), Certified Coding Specialist for Providers (CCS-P), Certified Coding Specialist for Hospitals (CCS-H), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA), or nursing medical background.
• Extensive knowledge of ICD-10-CM and CMS coding principles and guidelines.
• Familiarity with physician-specific regulations and polices related to documentation and coding.
• Knowledgeable of Medicare Risk Adjustment.
• Proficiency with ICD-10-CM coding and guidelines.
• Must be detail oriented, self motivated, and have excellent organization skills. Candidate must possess and maintain one of the following certifications issued by American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC).

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an hourly rate of 23 – 35 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .

About Cigna Healthcare

Cigna Healthcare, a ision of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Title: Bilingual Registered Nurse

(Remote)

Location: Remote

Job Description:

Nice to meet you, we’re Vesta Healthcare.

Vesta Healthcare is a specialized medical group focused today on aging adults with long-term home care needs. We help these iniduals live happier, healthier lives by partnering with their aides and caregivers, as a key part of the care team. We use a combination of virtual care, home-based and mobile technologies, data integrations and partnerships with home care agencies to make the home an integrated setting of care with patients, and their Caregivers at the center.

Vesta is the Roman name for the goddess of home, hearth and family. She is the caregiver. Often unseen yet greatly revered, she puts others’ needs ahead of her own, keeping the hearth warm so the home and family can function.

We see Caregivers and recognize the power and potential they embody. More than just assistance, Caregivers are eyes, ears and hands in the home. Caregivers play the role of Doctor, Nurse, Pharmacist, EMT and more, but without support or guidance. That is where Vesta Healthcare comes in. Our program provides Caregivers with a personalized clinical team in their pocket. Our team links Caregivers to the people they care for and the other providers involved in their care. It’s an insurance covered benefit, so it’s available to most adults with Caregivers free of charge to them.

The ideal teammate would be an RN who is passionate about advocating for their patients. Someone who will ensure our members have a safe transition between a healthcare facility and their home. They understand the hardships patients and their caregivers can encounter during transitions of care events and have the clinical skills and ability to catch onto warning signs of acute symptoms/exacerbations of certain chronic conditions and escalate as needed.

The ideal teammate would be able to:

• Support patients and their caregivers during transitions of care events by serving as their advocate and resource.
• Conduct assessments to identify expected patient needs for discharge, and coordinate meeting those needs with their provider team in a timely manner.
• Evaluate the patient’s understanding of their discharge care instructions and their chronic health conditions, providing education and support as needed for effective self-management.
• Coordinate routine check-ins with patients and their caregivers during their first 30 days post-discharge to identify care plan barriers and provide early interventions to mitigate preventable readmissions.
• Provide ongoing reassessment and determine the need for escalation as needed to improve patient outcomes.
• Navigate various platforms for documentation and retrieval of member information.

Would you describe yourself as someone who has:

• Available to work Monday – Friday, 9:00 am – 6:00 pm EST (required)
• Has an active Registered Nurse license in the state of New York AND a Compact license (required)
• Is bilingual and fluent in both English and Spanish (required)
• Graduated from an accredited nursing program (required)
• 1+ years of experience as a Transitional Care Manager RN in an outpatient setting (not a hospital setting) (required)
• 2+ years of nursing assessment experience in an acute setting (required)
• The ability to work remotely and has a private area in their home/workspace (required)
• A genuine, compassionate desire to serve others and help those in need
• High speed home WiFi/data connection to support company provided IT equipment

In addition to amazing teammates, we also offer:

• Health, dental, and vision insurance with a choice of many different plans/costs partially subsidized by us
• Paid vacation
• Paid Sick/personal days
• 12 paid holidays
• One time reimbursement to set up your home office
• Monthly reimbursement for internet or other home office expenses
• Monthly gym reimbursement to be used for gyms membership and classes
• Basic Life & AD&D, Short-term and Long-term Disability Benefits paid fully by us
• Voluntary benefits such as Pet, Home and Auto, Legal Insurance plus more
• Pre-tax Flex Spending/Dependent Care/Transit accounts
• 401k with a match

Pay range is $85,000-$101,000 based on experience. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).

If yes, then we look forward to speaking with you!

Vesta Healthcare is committed to leveraging the talent of a erse workforce to create great opportunities for our business and our people. Vesta Healthcare is an Equal Opportunity/Affirmative Action Employer. Candidates are selected without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.

At Vesta Healthcare, we are constantly searching for the most dynamic and best talent to join our team with a mission of empowering caregivers in the home!

If you are ever contacted by e-mail from any domain other than https://vestahealthcare.com, please do not respond, as there is a likelihood it could be a scam as it is not a legitimate Vesta Healthcare email. You might see things from a similar domain address, but with a slight misspelling, for example. We have no responsibility for any communication that does not come from the https://vestahealthcare.com domain, and we strongly advise that you not provide information or respond if not from the legitimate Vesta Healthcare domain. If you have any concerns that outreach might not be legitimate, please reach out to [email protected] for confirmation.

Instructor – Family Nurse Practitioner

locations

United States – Remote

time type

Full time

job requisition id

JR-017672

If youre passionate about building a better future for iniduals, communities, and our countryand youre committed to working hard to play your part in building that futureconsider WGU as the next step in your career.

Driven by a mission to expand access to higher education through online, competency-based degree programs, WGU is also committed to being a great place to work for a erse workforce of student-focused professionals. The university has pioneered a new way to learn in the 21st century, one that has received praise from academic, industry, government, and media leaders. Whatever your role, working for WGU gives you a part to play in helping students graduate, creating a better tomorrow for themselves and their families.

Job Profile Summary:

Student learning is the primary responsibility of WGU faculty. Instructors are subject matter experts who teach and support a caseload of students enrolled in their assigned course(s). Instructors offer specialized instruction on topics in their course(s) aligned with best practices, as well as monitor and support student progress in competency development and course completion. They are responsive to learner needs and vary the type, length, method, and intensity of instruction best matched to the learners strengths and goals. Using technology, Instructors may interact with students in both group and one-on-one settings. Instructors collaborate with other instructional and program faculty serving the students in their course to ensure continuity and quality of support.

Essential Functions and Responsibilities:

• Acts as a steward for carrying out WGUs mission and strategic vision by demonstrating effective and consistent commitment to learner-centered, competency-based educational support.

• Responsible to monitor the course progress of an assigned group of learners in their course(s) and proactively offer support at key points of the student journey.

• Provides expertise in assigned content area and maintains current knowledge in their field.

• Fosters student learning through innovative, effective teaching practices.

• Responds with urgency to meet student needs and communicates professionally and respectfully with students and all other members of the WGU community.

• Offers timely support and outreach to students, including meeting service level agreements as outlined by their department.

• Uses technology-based teaching and communication platforms to aid students in the development of competencies.

• Collaborates with other professionals within the university to promote a positive, student-obsessed atmosphere.

• Participates in all required training activities.

• Responds with urgency to changing requirements, priorities, and short deadlines.

• Consistently exhibits WGU Leadership Principles.

• Other duties and responsibilities may be assigned as the position evolves.

Knowledge, Skill and Abilities:

• Demonstrated ability to customize instructional support for learners with a variety of needs and educational backgrounds.

• Must demonstrate technological competency: Proficiency in Microsoft Office (or similar) applications, virtual instructional platforms, and student management systems.

• Extraordinary customer service orientation.

• Strong verbal and written communication skills, with ability to present information clearly, concisely, and accurately; friendly, persuasive speaking and writing style.

• Well organized – conscientious and thorough with detail.

• Ability to use data to make decisions.

• Strong understanding, acceptance, adherence and promotion of the tenets of competency-based education in the WGU model.

Competencies:

Organizational or Student Impact:

• Accountable for decisions that impact inidual students.

• Creates or facilitates learning experiences that support students attainment of knowledge and skills.

• With specific guidance from senior faculty and program leaders, acts independently in executing teaching practice.

Problem Solving & Decision Making:

• Works on erse matters of limited complexity.

• Receives general direction from their immediate supervisor or manager.

• Effectively utilizes resources to address student concerns and inquiries.

• Supports student needs to help them achieve course or program outcomes at the inidual student level.

• Follows university and department established policies and best practices.

Communication & Influence:

• Communicates with students as appropriate to support student questions and needs.

• Communicates with fellow faculty members as appropriate within and outside of the department.

• Provides feedback regarding discipline and practice leadership.

Leadership & Talent Management

• Serves as a contributing and collegial member of teams.

• Adheres to learning and operational quality guidance and instructions.

• Supports initiatives within the area of specialty.

• Displays a positive attitude toward change and supports change management practices.

Minimum Qualifications:

• Master of Science in Nursing. Education must be from an accredited institution. Education is verified.

• 2 + years of experience in instruction within a postsecondary FNP educational setting, acquired within the last 5 years

• Minimum of 2 years FNP experience.

• Currently working as an FNP.

• Active, unencumbered license to practice as a Registered Nurse

• Current FNP certification(submit with resume at time of application)

• Ability to work a student-friendly schedule includes (evenings/weekends).

Preferred Qualifications:

• Doctorate, or terminal degree in a specific content area. Education must be from an accredited institution. Education is verified.

• Experience with distance education and distance learning students is preferred.

Department Specific Minimum Qualifications:

• Separate qualifications and/or licensure may be required for some degree programs.

• State and/or federal legislative requirements and/or college accreditation requirements may apply to maintain the necessary credentialing for this role.

• Qualifications and/or licensure/certifications vary by degree programs.

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.
• Works primarily from home within the continental United States and is available to travel to meetings as required.
• 10% travel may be required

Disclaimer: This Job Description has been designed to indicate the general nature, essential duties, and responsibilities of work performed by employees within this classification. It does not contain a comprehensive inventory of all duties, responsibilities, and qualifications that are required of the employee to do this job. Duties, responsibilities and activities may change at any time with or without notice. This Job Description does not constitute a contract of employment and the University may exercise its employment-at-will rights at any time.

#LI-REMOTE #LI-TT1

The salary range for this position takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs.

At WGU, it is not typical for an inidual to be hired at or near the top of the range for their position, and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is:

Pay Range: $59,900.00 – $89,900.00

WGU will accept applications for this position until 06/19/2024

How to apply: apply online

Full-time Regular Positions(FT classification, standard working hours = 40)

This is a full-time, regular position that is eligible for bonuses; medical, dental, vision, telehealth and mental healthcare; health savings account and flexible spending account; basic and voluntary life insurance; disability coverage; accident, critical illness and hospital indemnity supplemental coverages; legal and identity theft coverage; retirement savings plan; wellbeing program; discounted WGU tuition; and paid vacation, holidays, sick time, and parental leave.

The University is an equal opportunity employer.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Risk Adjustment Coder

locations

Remote

Full time

Position: Risk Adjustment Coder

Department: Clinical Documentation

Schedule: Full Time

POSITION SUMMARY:

The Risk Adjustment Coder determines the appropriate ICD10-CM diagnoses codes based on clinical documentation that follows the Official Guidelines for Coding and Reporting and Risk Adjustment guidelines for risk adjustment and Hierarchical Condition Categories (HCC). Risk adjustment coding relies on ICD-10-CM coding to assign risk scores to patients. The incumbent reviews retrospective medical record documentation and ensures that the codes are appropriately assigned. The outcome will be documentation that accurately and completely captures the clinical picture/severity of illness/complexity of the patient while providing specific and complete information to be utilized in coding, profiling and outcomes reporting of both the facility and the physicians. The Risk Adjustment Coder utilizes standards of compliance, specifically in OP compliant query processes and clinical knowledge to identify opportunities and to achieve results Also required is advanced knowledge of CPT, ICD-10-CM, and HCPCS coding systems.

JOB REQUIREMENTS

EDUCATION:

High school diploma or equivalent medical coding education. Associates Degree preferred (or direct work experience equivalent to at least 2 years)

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required. Certification may include Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) and/or Certified Clinical Documentation Specialist- Outpatient or Certified Documentation Expert Outpatient (CDEO) Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P), or a Certified Coding Associate (CCA), or Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) required

EXPERIENCE:

Minimum of two (2) years progressive coding experience in multiple specialties, HCC Risk adjustment Coding

KNOWLEDGE AND SKILLS:

• Willing to work as a team innovation and collaboration is a priority
• Experience with an Electronic Medical Record (EMR), EPIC preferred
• Knowledge of AHA coding guidelines and methodologies: HCCs and other RA methodologies, ICD-10-CM coding guidelines, Office of Inspector General (OIG) and Federal and State regulations
• Extensive knowledge of medical terminology, anatomy, and pathophysiology, pharmacology, and ancillary test results
• Strong organization and analytical thinking skills detail oriented
• Proficient with Microsoft Office applications (Outlook, Word, Excel)
• Demonstrates critical thinking skills, able to assess, evaluate, and teach
• Self-motivated and able to work independently without close supervision
• Strong communication skills (interpersonal, verbal and written)
• Medical Record audits and review
• Familiarity with the external reporting aspects of healthcare
• Familiarity with the business aspects of healthcare, including prospective payment systems
• Proficient with computer applications (MS Office etc.), Excellent data entry skills
• Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.
• Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
• Ability to work with accuracy and attention to detail
• Ability to solve problems appropriately using job knowledge and current policies/procedures.
• Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests.
• Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Review documentation available in the Medical Record to facilitate workflows that support the clinical picture/severity of illness/complexity of the patient care rendered to patients.
• Reviews medical records to ensure accurate codes are applied to the encounter.
• Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM diagnosis codes mapped to HCCs or other RA methodologies
• Actively participate in and maintain coding quality and productivity processes
• Collaborates with nursing or coding staff on retrospective medical record review for severity, accuracy, and quality issues.
• Ensure documentation in the medical record follows the official coding guidelines, internal guidelines and the
• AHIMA/ACDIS physician query brief.
• Create and analyze reports for coding improvement trending and high-level dashboards for ongoing monitoring and opportunities.
• Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements.
• Assist with educational in-services for physicians, other providers, and clinic staff relating to coding and documentation compliance as well as new policies and procedures related to billing.
• Participate in training new coding staff, as needed.

Title: Healthcare Customer Service Representative – Remote

Location: IN-

Job Description:

Teleperformance is a global, digital business services company. We deliver the most advanced, digitally powered business services to help the world’s best brands streamline their business in meaningful and sustainable ways.

With more than 500,000 inspired and passionate people speaking more than 300 languages, our global scale and local presence allow us to be a force of good in supporting our communities, our clients, and the environment.

Benefits of working with TP include:

• Paid Training
• Competitive Wages
• Full Benefits (Medical, Dental, Vision, 401k and more)
• Paid Time Off
• Employee wellness and engagement programs

Teleperformance and You

Through a balanced high-tech and high-touch approach blended with deep industry and geographic expertise, we make people’s lives simpler, faster, and safer. We help companies adapt quickly to changing needs, and are inspired to deliver only the best in all that we do. You will become a key contributor in making that happen.

As the eyes and ears for our team fielding customer inquiries and finding innovative ways to respond, you will work in a collaborative and engaging environment. You will have the chance to interact with people from all walks of life, and no two days will be the same. As you continue to grow and challenge yourself, you will discover your potential can take you anywhere you want to go.

Did you know that our Chief Client Officer started her career at Teleperformance as an agent and advanced to the pinnacle of the company? At Teleperformance, the sky is the limit!

At this time, Teleperformance can only offer employment to iniduals located in the following states: AL, AR, AZ, CT, DE, FL, GA, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, PA, RI, SC, SD, TN, TX, UT, VA, VT, WI, WV, WY

Responsibilities

Your Responsibilities

Healthcare Customer Service Representatives field customer inquiries by finding innovative ways to respond to varying questions, issues, and concerns.

• Connect with customers via phone/email/chat/and or social media to resolve their questions or concerns
• Calmly attempt to resolve and de-escalate any issues
• Escalate interactions when necessary and appropriate
• Respond to requests for assistance and/or possible processing payments
• Track all call related information for auditing and reporting purposes
• Provide feedback on call issues
• Upsell if required

Qualifications

We’re looking for fearless people – people who are inspired to deliver only the best in all that we do.

• Ability to work remotely in a virtual team environment
• 6 months Customer service experience preferred
• Over 18 years of age
• Ability to type 25 wpm
• High School Graduate or GED
• Comfort with desktop computer system
• Proven oral & written communication skills
• Logical problem-solving skills
• Ability to navigate Windows operating systems
• Organization and work prioritization skills

Work from Home Requirements:

• Internet Connection Requirements:
  • Minimum subscribed download rate equal or exceeds 12.0 Mbps
  • Minimum subscribed upload rate equal or exceeds 3.0 Mbps
  • ISP must have no packet loss and ping under 50ms
  • Proof of internet speed required
• Clean and quiet workspace

Be Part of Our TP Family

It is our mission to always provide an environment where our employees feel valued, inspired, and supported, so that they can bring their best selves to work every day. We believe that when employees are happy and healthy, they are more productive, creative, and engaged. We are committed to providing a workplace that is conducive to happiness and a healthy work-life balance. We also believe that to be our best selves, we need to be surrounded by people who are positive, supportive, and challenging. We are committed to creating a culture of inclusion and ersity, where everyone feels welcome and valued.

Title: Nurse Practitioner [Remote / WFH] (Remote)

Location: Winnipeg MB CA

• Part-Time
• Medical
• $70.00- $100.00/ hr

The role:

Cloudcure is looking for a Nurse Practitioner with experience in offering patient facing care. Collaboration and learning are both significant aspects of this role.

This is an exciting role that offers the opportunity to join the team at an early stage with exciting potential for career growth.

Responsibilities:

Performing clinical assessments, evaluations and taking patient history

Offering treatment options and guidance to patients on our platform Order, interpret and perform diagnostic tests Develop plans for care including prescribing medications or therapies Collaborate and consult with care team and stakeholders as needed Embrace and model our culture of treating each patient with respect and enthusiasm, and ensuring that the team delivers client care excellence

Qualifications & Experience:

Masters degree in Nursing and/or accredited as Nurse Practitioner

Hold a valid and active permit to practice in MB as a Nurse Practitioner (Primary care or Adult) Desire to work in an innovative, dynamic environment that encourages professionalism, patient outcomes and experience, and autonomy

Bonus points:

Interest or prior experience in digital health

Registered in additional provinces

Perks:

Join a growing startup and help chart the course

Development and advancement opportunities as an early hire Competitive compensation Flexible work schedule and hours Remote or hybrid work

About us

We are a growing team with a vision to create Canada’s most innovative digital healthcare company, enabling healthier outcomes for our patients.

Our company is proud to be a erse and equal opportunity employer and as such does not discriminate on the basis of race, color, religion, sex, national origins, age, sexual orientation, disability, or any other characteristic protected by applicable laws. Selection decisions are solely based on job-related factors.

If you require accommodation during the interview process, please let the recruiter know when contacted for an interview.

Profee Clinic Coder

Remote – US

Full time

JR100920

The Profee Clinic Coder will handle medical coding and data entry / abstraction for various types of clinic visits.

Essential Functions: In addition to working as prescribed in our Performance Factors specific responsibilities of this role may include:

• OUTPATIENT: Correctly assigns modifiers to chargemaster items and coder assigned CPT codes as applicable to outpatient coding, as appropriate.
• Ability to create compliant physician queries
• Accurately review claims for medical necessity
• Update problem lists consistent with client contract
• Ability to provide excellent customer service to our clients and teammates.
• Consistently demonstrates an excellent attitude and works to strengthen the team as a whole.
• Floats between multiple sites and coding specialties with ease and flexibility.

Minimum Requirements:

Education/Experience/Certification Requirements

• 2 year degree or equivalent experience; AHIMA or AAPC certification required
• Profee Clinic Coding experience required
• Indian Health experience preferred, but not required
• Actively holds one or more of the following credentials: RHIA, RHIT, CCS, CPC, COC
• Minimum of 1-3 + years-experience coding preferred
• Floats between multiple sites and coding specialties with ease and flexibility.
• Meets or exceeds Quality and Productivity standards.
• Excellent communication (written and oral) and interpersonal skills.
• Strong organizational, multi-tasking, and time-management skills.
• Must be detail oriented and able to follow through on issues to resolution.
• Must be able to act both independently and as a team member.

Why join our team?

If you join us, you will receive:

• Work remotely with a work/life balance approach
• Robust benefits offering, including 401(k)
• Generous time off allotments
• 10 paid holidays annually
• Employer-paid short term disability and life insurance
• Paid Parental Leave

Certified Coder/Analyst

Location: Carmel, NY, United States

Requisition ID: 8997 Salary Range: 17.07 – 32.47 HOURLY Work Shift: Monday-Friday Day Shift FT/PT/PD: FULL-TIME Exempt/Non-Exempt: Non-Exempt

Description

Remote Coder positions are available in all statesEXCEPT CA and HI

Nuvance Health has a network of convenient hospital and outpatient locations Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York plus multiple primary and specialty care physician practices locations.

Purpose:Accurately codes and abstracts outpatient medical records for reimbursement and statistical purposes using established coding guidelines. Reviews coding and amends coding edits to assure compliance with all applicable regulations.

Essential Responsibilities

• Codes all outpatient medical records in a timely and accurate manner according to department policy – ED (Emergency Department), Facilities, Injection & Infusion Outpatient Coding
• Defines and transforms verbal descriptions of diseases, injuries, and procedures into numerical designations (codes) using ICD-10-CM and CPT-4 according to established coding guidelines
• Initiates a physician/department query when there is conflicting, incomplete, or ambiguous documentation in the record or additional information is needed for accurate coding
• Enters all required information accurately into computer system for reimbursement and statistical purposes
• Remains abreast of all applicable Federal, State, regulatory and hospital-specific coding guidelines
• Applies applicable guidelines to all cases coded to ensure accuracy of selected codes
• Accesses and research applicable reference materials to further support decision-making in code selection
• Participates in Performance Improvement/Quality Assurance activities
• Reports on software and hardware problems
• Attends required educational sessions (webinars, conferences etc.) to maintain and enhance coding certification(s)
• Maintain and Model Nuvance Health Values
• Demonstrates regular, reliable, and predictable attendance
• Performs other duties as required

Education and Experience Requirements:

• Associates degree or equivalent
• 4 years of coding experience in ED (Emergency Department), Facilities, Injection & Infusion Outpatient Coding

Minimum Knowledge, Skills and Abilities Requirements:

• Knowledge of ICD-10, CPT-4, Disease Pathology, Anatomy, Physiology and Medical Terminology
• Advanced knowledge of ED (Emergency Department), Facilities, Injection & Infusion Outpatient Codingguidelines
• Basic familiarity with MS Office applications (Word, Excel. Outlook)
• Usage of coding manuals and regulatory websites for research

License, Registration, or Certification Requirements:

• Required: Certification from the America Academy Professional Coders (AAPC) or the American Health Information Management Association (AHIMA): CPC or CCS

Work Type: Full-Time

Standard Hours: 40.00

Work Shift: Monday-Friday Day Shift

Org Unit: 879

Department: Health Information Management

Exempt: No

Grade: U4

Salary Range: $16.32-$31.05

EOE, including disability/vets.

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities

Coding Auditor

General information

Job Title

Coding Auditor

Functional Area

Teammate – Revenue Cycle

City

Remote

Work Location Type

Remote

State

Remote

Employment Type

Full-time (30+ hrs/week)/FULLTIME

Description & Requirements

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Position Description & Requirements

PRACTICE OVERVIEW

Radiology Partners, through its owned and affiliated practices, is a leading radiology practice in the U.S., serving hospitals and other healthcare facilities across the nation. As a physician-led and physician-owned practice, we advance our bold mission by innovating across clinical value, technology, service and economics, while elevating the role of radiology and radiologists in healthcare.Radiology is a team sport, and Radiology Partners is building a community of physicians and support teammates who embody our practice values and believe in our bold mission to transform radiology.Our support team is a vital force within the practice, using their gifts and talents to improve the overall healthcare experience.Using a proven healthcare services model, Radiology Partners provides consistent, high-quality care to patients, while delivering enhanced value to the hospitals, clinics, imaging centers and referring physicians we serve.

POSITION SUMMARY

Radiology Partners is seeking a Medical Coding Auditor who will be accountablefor conducting coding and data quality audits of all imaging modalities in the Coding department. The Medical Coding Auditor will be responsible for correcting coding errors, reviewing denials and providing thorough investigation of re-coding for submission. Will work with the Coding Manager on implementing the coding review workflow that includes but not limited to sampling methodology, medical record review/audit approach, validation criteria, audit result reporting, root cause analysis and corrective action plan.

POSITION DUTIES AND RESPONSIBILITIES

Review medical records for the determination of accurate assignment of all documented ICD 10 codes for diagnoses and procedures

Validate and correct coding errors for all aspects of the charge. Perform all other duties as assigned

Investigate and recode any applicable denials after thorough research

Provide real time dictation feedback, audit feedback and/or education/training to physicians, coders and other teammates on coding and clinical documentation and communicate for need for documentation to ensure accurate coding

Demonstrate ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses and procedures

Identify and communicate documentation improvement opportunities and coding issues (lacking documentation, physician queries, etc.) to Coding Manager for follow-up and resolution

Evaluate and prepare as indicated daily, weekly and monthly reports indicating coding quality levels and opportunities for charge capture and revenue integrity

Monitor, prepare and present reports including, but not limited to, coding accuracy, medical record deficiency, coding validation discrepancies or completeness of procedure report

Stay current with AHA Official Coding and Reporting Guidelines, CMS, ACR, AMA and other agency directives for coding

Attend coding seminars on annual basis for outpatient coding

Perform other reasonably related duties assigned by the Coding Manager or other management

Provide coverage when available or needed in the department

Perform other reasonably related duties assigned by the Coding Manager or other management

DESIRED PROFESSIONAL SKILLS AND EXPERIENCE

2+ years related coding audit or medical record review experience

Must be detail oriented and have the ability to work independently

Computer knowledge of MS Office and proficient in internet resources

Extensive knowledge of medical record documentation requirements mandated by AMA, ACR, AHA, State and federal regulations

Excellent verbal/written communication and interpersonal skills

Advanced/Thorough/detailed knowledge of ICD-10 and CPT coding systems

Skilled in performing coding quality assessment/analysis

High School Graduate or GED equivalent preferred, and some level of advance study highly preferred

Previous coding experience a must

Computer software skills and knowledge required

RCC certification or other qualified coding certification required

Must have extensive knowledge of anatomy, medical terminology, CPT, ICD-10, HCPCS, Modifiers & PQRS codes

Radiology Partners is an equal opportunity employer.RP is committed to being an inclusive, safe and welcoming environmentwhereeveryone hasequal access and equitable resources to reach their fullpotential.We are united by our Mission to Transform Radiology and in turn have animportantimpacton the patients we serve and the healthcare systemoverall.We hold that ersity is a key source of strength from which we will build apracticeculturethat is inclusive for all.Our goal is to empower and engage the voice of every teammate topromoteawareness,compassion and a healthy respect for differences.

The hourly range for this position is $27.50 – $30.00. Final determinations may vary based on several factors including but not limited to education, work experience, certifications, geographic location etc. In addition to this range, Radiology Partners offers competitive total rewards packages, which include possible incentive and productivity programs, health & wellness coverage options, 401k benefits, and a broad range of other benefits such as family planning and telehealth (all benefits are subject to eligibility requirements).

• : When you submit a job application or resume, you are providing the Practice with the following categories of personal information that the Practice will use for the purpose of evaluating your candidacy for employment: (1) Personal Identifiers; and (2) Education and Employment History.

Cardiometabolic Nurse Practitioner

• Remote USA
• Full time
• R1943

At Devoted Health, were on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. Thats why were gathering smart, erse, and big-hearted people to create a new kind of all-in-one healthcare company one that combines compassion, health insurance, clinical care, service, and technology–to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we’ve grown fast and now serve members across the United States. And we’ve just started. So join us on this mission!

Job Description

A bit more about this role:

This position represents an amazing opportunity for a nurse practitioner (APRN) with a big heart and entrepreneurial spirit with extensive clinical experience offering cardiometabolic preventive care. Your primary focus will be delivering world class care to our members with hypertension, hyperlipidemia, diabetes and coronary artery disease.

In this role you will be working in a next generation virtual cardiometabolic clinic that dramatically expands access to care for America’s most vulnerable seniors. The clinic focuses on optimizing hypertension and hyperlipidemia management for Devoted Health members. You will utilize and help improve our home-grown technology and electronic health information platform to carry out virtual visits as well as managing asynchronous prescription refills for patients. On a day-to-day basis you will work closely with our virtual specialty clinic team members at Devoted Medical including physicians and other APRNs as well as medical assistants, clinical guides (nurses, dieticians, health coaches), pharmacists, and pharmacy techs. You will be a key member of our interprofessional team.

The hypertension/ cardiometabolic clinic is one of several of Devoted’s virtual specialty care programs that are designed as micro centers of excellence that deliver highly tailored, specialized care to patients with a specific chronic conditions.

Responsibilities will include:

• Conduct focused and thorough assessments of patients with conditions that impact cardiometabolic health including hypertension, hyperlipidemia, coronary artery disease, and diabetes through virtual consultations including ordering diagnostics as needed, interpreting labs and imaging data, and developing a treatment plan in collaboration with the specialty care clinic team. We expect that 60-70% of your clinical effort will be performing virtual visits.
• Formulate accurate diagnoses and develop inidualized treatment plans for patients with cardiometabolic conditions, including medication management, lifestyle modifications, and monitoring recommendations.
• Mitigate the risk of cardiometabolic conditions by proactively managing medication adherence for patients with hypertension, hyperlipidemia, diabetes and atherosclerotic cardiovascular disease.
• Manage a refill inbox for patients with cardiometabolic conditions in accordance with established protocols and guidelines. We expect that 30%-40% of your clinical effort will be managing a prescription refill queue.
• Identify and evaluate risk factors, comorbidities and possible contraindications for treatment.
• Provide counseling on medication adherence, potential side effects.
• Collaborate closely with other members of the care team including PCPs, endocrinologists, cardiologists and other Devoted team members including pharmacy, clinical nursing, social work, as well as interfacing with family members and caregivers to coordinate holistic care for the member, to ensure continuity of care and deliver a collaborative care plan.
• Serve as the clinical advisor and provide clinical escalation support for the speciality clinic staff and other teams during business hours.
• Utilize our home grown electronic health information system for visits while also providing feedback on how to improve the interface.
• Maintain accurate and up-to-date patient medical records, ensuring compliance with relevant legal and ethical guidelines.
• Participate in quality improvement initiatives and ongoing professional development to stay current on best practices and advancements in cardiometabolic care.
• Adhere to all relevant laws, regulations, and industry standards, including patient privacy and telehealth regulations.
• Conduct urgent visits during on-call shifts to support our clinical nurses who triage calls from our members. At least one four hour on-call shift on a weekend day or holiday is required per quarter.

Attributes to success:

• Skilled nurse practitioner with thorough understanding of cardiometabolic condition management including disease process, treatment modalities, medication management and lifestyle modification as it pertains to hypertension, hyperlipidemia, and primary care management of coronary artery disease and diabetes.
• You are experienced working on an interprofessional team and enjoy team-based care.
• You have great clinical and non-clinical judgment.
• You are thorough and take the time to address the needs of your patients.
• You are deeply empathetic and humanistic, and want to go the last mile for your patients.
• You enjoy a fast-paced, high-energy, organization. Agility and collaboration are key as we will change and improve quickly.
• You welcome learning and using new technologies that are being developed in parallel. You thrive on knowing your work can help make these technologies better for you and your patients.
• You learn from every experience and are not afraid to fail – that’s how you’re wired.
• Finally and most importantly, you have a passion for making healthcare better, solving complex problems, and supporting the delivery of healthcare that we would want for our own family members.

Desired skills and experience:

• APRN with 5 or more years working in outpatient clinical practice ideally with experience in management of hypertension, hyperlipidemia and primary and secondary prevention of atherosclerotic cardiovascular disease.
• Minimum of 2 years of experience concentrated in primary care or a subspecialty with heavy focus on hypertension and lipid management required (eg. cardiology, nephrology, endocrinology, primary care).
• Proficiency in using telehealth technology and electronic health records (EHR).
• Virtual care experience is preferred along with a strong desire to continue practicing clinical nursing and performing virtual visits – you believe in the mission of bringing care to where the patient lives.
• An understanding of managed care is a plus, including how to appropriately assess STARS/HEDIS measures, code clinical comorbidities, and identify clinical care gaps.
• Proficiency in English and Spanish preferred for this position.
• Multi-state licensure is required in addition to a willingness to obtain, and maintain, additional licensure as requested.

Licensure and Certification:

• Master’s or Doctoral degree in Nursing with a specialization in primary care or cardiovascular care.
• An active and clear RN and APRN license in the state of [MARKET] as well as APRN certification is required at time of hire and must be maintained while employed at Devoted Medical.
• Active BLS is required at time of hire and must be maintained while employed at Devoted Medical.

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the inidual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more….

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoteds mission to treat our members like family. We are committed to a erse and vibrant workforce.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value ersity and collaboration. Iniduals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoteds Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

Corporate Communications Lead

Location:Nationwide

Location Type:Remote

Schedule:Full-time

Become a part of our caring community and help us put health first

Humana’s Corporate Communications organization is seeking a Corporate Communications Lead to join the Associate Communications Team. As the Lead, you will be responsible for the development, planning, and delivery of comprehensive communications strategies that support Humanas healthcare services organization. You will own and execute the overarching communications strategy for the Office of the Chief Medical Officer, with a focus on driving associate engagement within Humanas clinical communities. Additionally, you will provide executive-level communications support to the Office of the Chief Medical Officer and lead large-scale enterprise and segment campaigns in partnership with External Communications, the Chief Nursing Organization, Physicians Collaborative, and other functional workstreams.

Key Role Functions

• Collaborates with teammates within CenterWell, Corporate Communications, Office of the Chief Medical Officer, HR and other key functions to produce integrated communications plans, narratives and tactics aligned to business goals and objectives
• Prioritizes communications thatdrivedeeper engagement and connection within Humanas clinical communities of practice
• Works with cross-functional partners to develop high-impact communications on a variety of topics reaching broad and targeted audiences, including leaders and frontline employees
• Establishes project plans to support an integrated approach, town halls and events, executive visibility, and more
• Leverages data to implement new or enhanced communications practices for improved effectiveness and reach
• Champions new ways of working through digital tools for greater efficiencies
• Maintains brand standards and guidelines for improved quality and communications governance

A successful candidate is highly skilled at strategic planning, employee engagement, executive communications, and translating company goals into effective messaging that reaches a variety of audiences, including frontline clinicians. The inidual must demonstrate a deep knowledge of communications channels and emerging technologies, possess exceptional communication skills (verbal and written), and connect across the business todrivealignment around communications goals, strategies and tactics.

Use your skills to make an impact

Required Qualifications

• Bachelors degree in journalism, communications, public relations, or relevant field
• 10+ years of recent experience in corporate communications focused on healthcare, M&A, executive communications, and/or employee engagement
• Demonstrated history developing, implementing and measuring integrated communications strategies that drive results
• Experience building and maintaining best-in-class communications experiences using a multi-channel approach
• Ability to deploy enterprise communications programs to targeted stakeholders and business functions
• Exceptional interpersonal skills, with the ability to influence and build relationships with key stakeholders and senior leadership
• Ability to work under tight deadlines without compromising quality
• Self-organized can independently plan, lead and implement integrated communications projects

Preferred Qualifications

• Education or Certification in Organizational Change Management
• Experience working at a large, matrixed organization
• Healthcare or insurance communications experience
• Previous experience in project management

Additional Information

To ensure Home or HybridHome/Office employees ability to work effectively, the self-provided internet service of Home orHybridHome/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home orHybridHome/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial securityboth today and in the future, including:

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from [email protected] with instructions on how to add the information into your official application on Humanas secure website.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and inidual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$102,200 $140,700 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or inidual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, Humana) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Nurse Clinical Care Reviewer

Location: US-Remote

JobDescription:

This position will be filled by a nurse to serve as a Nurse Clinical Care Reviewer for the Medical Benefits and Certifications Unit. The Nurse Clinical Care Reviewer will participate in all aspects of medical benefit decisions for responders and survivors of the 9/11 attacks. These decisions include, but are not limited to; certification decisions for new health conditions and health care benefit prior authorization requests.

In addition, the Nurse Clinical Care Reviewer may provide recommendations for services that are cost-effective and in compliance with Program regulations and guidelines. The Nurse Clinical Care Reviewer will make recommendations based on Program statutes, policy, collaboration with experts, clinical research and their own clinical and professional judgement and analytical skills. Additional duties include managing complex program deliverables, analyzing and manipulating medical claims data and collaborating with occupational health subject matter experts. The Nurse Clinical Care Reviewer will interface with clinicians, medical administrators, and a erse set of federal and contract staff. The work requires excellent organizational, verbal and written communication skills, attention to detail, innovative problem solving, and self-initiation. The WTC Health Program leadership and management team will provide guidance commensurate with the Nurse Clinical Care Reviewer ‘s level of duties.

Essential Functions and Job Responsibilities

• Reviews and makes recommendations on requests for certification of health conditions, in alignment with Program guidelines and policies, permitting member access to treatment benefits.

• Analyzes and makes recommendations in writing against Program regulations and guidelines and evidence-based clinical guidelines for clinical service requests from health care providers. • Appropriately prioritizes and tracks all certification and prior authorization requests, reviewing them for completeness and alignment with Program policy and requirements; makes recommendations to approve or deny these requests using clinical and professional judgement and analytical skills within required timeframe. • Collaborates with subject matter experts when making decisions and recommendations. • Requests additional information from providers in a consistent and efficient manner with superior customer service. • Liaises with denial and appeal coordinators for denial decisions. Creates denial letters and collaborates with the Office of General Counsel to review. • Educates clinical center staff/providers regarding certification requests, authorization requirements, eligibility guidelines, and documentation requirements. • Provides analytic support of cost and utilization reporting. • Understands complex legislative, regulatory, and/or policy guidance for use in executing daily activities. • Monitors, coordinates and tracks multi-functional program deliverables, ensuring deadlines are met.

The work entails both clinical and administrative aspects of health care delivery within a federal managed care system and involves collaboration with both clinicians and medical administrators. The WTC Health Program Medical Benefits and Certifications Unit Chief will provide support and guidance to the contractor in the performance of these deliverables.

Minimum Requirements

Special Considerations or Requirements:

The knowledge, skills and abilities are specific in this task area and shall include: Completion of an accredited Registered Nurse (RN) Program preferred OR a Bachelor’s Degree in a healthcare field, such as social work or clinical counselor may be considered.

Required Experience

• 1-3 years’ experience working in a health care or managed care setting. • Experience working in a managed care/clinical setting or with payer claims data in a health plan preferred, but not required. • Proficient in Microsoft Office Suites, including Excel, Outlook, SharePoint; Proficiency with MS Windows Office programs, including MS Word, Excel, and Outlook to create complex documents, manage schedules, and analyze data.

Company Benefits

PSI offers full-time, benefits eligible employees a competitive total compensation package that includes paid leave, and options for employer sponsored group medical, dental, vision, short-term and long-term disability, life insurance, AD&D coverage, legal services, identity theft, and accident insurance. Flexible spending account and health saving account options offer pre-tax savings for qualified medical, dental, and vision expenses. The company sponsored 401(k) retirement plan has an employer contribution match that is immediately vested. We invest in the professional growth of our employees through professional courses, certifications, and tuition reimbursement programs.

EEO Commitment

It is company policy to promote equal employment opportunities. All personnel decisions, including, but not limited to, recruiting, hiring, training, promotion, compensation, benefits, and termination, are made without regard to race, color, religion, age, sex, sexual orientation, pregnancy, gender identity, genetic information, national origin, citizenship status, veteran status, protected veteran status, disability, or any other characteristic protected by applicable federal, state, or local law.

Utilization Review Nurse- FT (12a-8a EST)

locations

Remote – Other

time type

Full time

job requisition id

R012827

Responsible for utilization review work for emergency admissions and continued stay reviews.

Responsibilities

• Review electronic medical records of emergency department admissions and screen for medical necessity, using InterQual or MCG criteria.
• Participate in telephonic discussions with emergency department physicians relative to documentation and admission status.
• Enter clinical review information into system for transmission to insurance companies for authorization.

Qualifications

Required

• Current RN licensure
• At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
• At least 2 years utilization management experience in acute admission and concurrent reviews
• Intermediate level experience with InterQual and/or MCG criteria within the last two years
• Proficiency in medical record review in an electronic medical record (EMR)
• Experience in MS Office and basic Excel
• Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs
• Passing score(s) on job-related pre-employment assessment(s)

Preferred

• 3+ years utilization management experience within the hospital setting
• Bachelors of Science in Nursing
• Proficient in InterQual/MCG criteria
• Case Management Certification (CCM, ACM, CMCN, or CMGT-BC

Expectations

• This job operates in a remote environment that must be private. This role routinely uses standard office equipment such as computers, phones, and printers.
• Hours will vary, including two weekends a month.
• Must be able to remain in a stationary position 50% of the time and constantly operate a computer.
• Frequently communicates with internal, external and executive personnel and must be able to listen and exchange accurate information.

Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all iniduals. We celebrate ersity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmarts sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the inidual can provide proof of valid prescription to Netsmarts third party screening provider.

If you are located in a state which grants you the right to receive information on salary range, pay scale, description of benefits or other compensation for this position, please use this form to request details which you may be legally entitled.

All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position.

Title: Senior Director, Strategic Health Systems

Location: Remote US

JobDescription:

Boldly innovating to create trusted solutions that detect, predict, and prevent disease.

Discover your power to innovate while making a difference in patients’ lives. iRhythm is advancing cardiac careJoin Us Now!

At iRhythm, we are dedicated, self-motivated, and driven to do the right thing for our patients, clinicians, and coworkers. Our leadership is focused and committed to iRhythms employees and the mission of the company. We are better together, embrace change and help one another. We are Thinking Bigger and Moving Faster.

About This Role

We are seeking a highly experienced and strategic Senior Director of Health Systems to join our dynamic team at iRhythm Technologies. The Senior Director will play a pivotal role in driving the adoption and integration of our cardiac monitoring solutions within healthcare systems. This inidual will lead the development and execution of strategies to establish partnerships with health systems, hospitals, and other key stakeholders to ensure the successful implementation and utilization of our products. Additionally, the Senior Director will lead a team of Strategic Health System Directors, providing leadership and guidance to drive collective success in expanding our footprint within health systems. This role will report into the Vice President, US Sales.

Responsibilities:

1. Develop and implement comprehensive strategies to drive the adoption and utilization of our cardiac monitoring solutions within health systems and hospitals.
2. Build and nurture strong relationships with key stakeholders, including C-suite executives, cardiologists, electrophysiologists, procurement officers, and IT leaders within health systems.
3. Lead and mentor a team of Strategic Health System Directors, providing guidance and support to facilitate the successful integration and utilization of our products across multiple health systems.
4. Collaborate with cross-functional teams, including sales, marketing, product development, and regulatory affairs, to ensure alignment of strategies and tactics to support health system partnerships.
5. Identify and pursue opportunities for strategic partnerships and collaborations with health systems to enhance market penetration and revenue growth.
6. Serve as the primary point of contact for health systems, providing guidance, support, and resources to facilitate the successful integration and utilization of our products.
7. Stay informed about market trends, competitor activities, and regulatory changes impacting health systems and hospitals within the cardiac monitoring space.
8. Develop and manage budgets, forecasts, and performance metrics related to health system partnerships and revenue goals.
9. Represent iRhythm Technologies at industry conferences, trade shows, and other events to promote our cardiac monitoring solutions and build relationships with key stakeholders.

Qualifications:

1. Bachelor’s degree in business, healthcare administration, or related field; MBA or advanced degree preferred.
2. Minimum of 12+ years of experience in healthcare sales, business development, or account management, with a focus on selling medical devices or technology solutions to health systems, preferably within the cardiac monitoring space. Minimum 3 years of leading a team required.
3. Proven track record of successfully establishing and managing strategic partnerships with health systems and hospitals.
4. Strong understanding of the healthcare industry, particularly in cardiac care, including knowledge of healthcare delivery systems, reimbursement mechanisms, and regulatory requirements.
5. Excellent communication, negotiation, and presentation skills, with the ability to effectively communicate complex concepts to erse audiences.
6. Demonstrated leadership abilities, with experience leading and developing high-performing teams.
7. Strategic thinker with the ability to develop and execute long-term business plans.
8. Ability to travel as needed.

What’s In It For You

This is a regular full-time position with competitive compensation package, excellent benefits including medical, dental, and vision insurances (all of which start on your first day), health savings account employer contributions (when enrolled in high deductible medical plan), cafeteria plan pre-taxed benefits (FSA, dependent care FSA, commute reimbursement accounts), travel reimbursement for medical care, noncontributory basic life insurance & short/ long term disability. Additionally, we offer:

• emotional health support for you and your loved ones
• legal / financial / identity theft/ pet and child referral assistance
• paid parental leave, paid holidays, travel assistance for personal trips and PTO!

iRhythm also provides additional benefits including 401(k) (with company match), an Employee Stock Purchase Plan, pet insurance discount, unlimited amount of Linked In Learning classes and so much more!

FLSA Status: Exempt

#LI-WB-1

#LI-Remote

Actual compensation may vary depending on job-related factors including knowledge, skills, experience, and work location.

Estimated Pay Range $201,600—$283,000 USD

As a part of our core values, we ensure a erse and inclusive workforce. We welcome and celebrate people of all backgrounds, experiences, skills, and perspectives. iRhythm Technologies, Inc. is an Equal Opportunity Employer. We will consider for employment all qualified applicants with arrest and conviction records in accordance with all applicable laws.

iRhythm provides reasonable accommodations for qualified iniduals with disabilities in job application procedures, including those who may have any difficulty using our online system. If you need such an accommodation, you may contact us at [email protected]

About iRhythm Technologies

iRhythm is a leading digital healthcare company that creates trusted solutions that detect, predict, and prevent disease. Combining wearable biosensors and cloud-based data analytics with powerful proprietary algorithms, iRhythm distills data from millions of heartbeats into clinically actionable information. Through a relentless focus on patient care, iRhythms vision is to deliver better data, better insights, and better health for all.

Make iRhythm your path forward. Zio, the heart monitor that changed the game.

Title: Medical Coder – Remote

Location: USA-

JobDescription:

Medical Coder – Remote

Munson Healthcare United States Coding and Data Integrity Svcs Day shift

Requisition #: 59614

Total hours worked per week: 40

Description

Experienced Outpatient Coders

Eligible $5,000 sign on bonus!

Find more than your next job. Find your community.

• We’re northern Michigan’s largest healthcare system and we are deeply rooted in the communities we serve. That means that our patients are often our family, friends and neighbors – and it’s special to be able to care for them. And as one of the top healthcare systems to work for in Michigan by Forbes (American’s Best Employers by State 2022), we’re committed to your ongoing growth and development.
• After work, you’ll find things to do in every season – beaches, outdoor recreation, unique restaurants, world-class wineries, arts and entertainment.

Why work as a Coder Abstractor at Munson Healthcare?

• Flexible remote work schedule
• Our dynamic work environment includes many opportunities for growth and development
• Our efforts directly impact patient satisfaction and outcomes
• Our employees work in positive, supportive, and compassionate environments built on our organizational values.

Summary:

The coding professional is a critical member of the Revenue Cycle Team and is responsible for coding and abstracting patient visit data for performance improvement, statistical research, administrative and facility financial purposes.

Coding is performed using utilizing ICD10-CM, ICD10-PCS and CPT-4 classification systems and is subject to the Official Guidelines for Coding and Reporting, AHIMA Code of Ethics “Standards of Ethical Coding”, AHA Coding Clinic and technical rules outlined by hospital guidelines.

The coding professional works closely with the Coding Analyst, Clinical Documentation Integrity Specialists and the Regional Coding Operations Coordinator. Required qualities include teamwork, ability to code various patient types for a variety of Munson facilities, and flexibility in handling work assignments while maintaining productivity and quality standards. This position supports the timely and accurate submission of facility claims and works to achieve or exceed the established Accounts Receivable goals for the Department.

What’s Required:

• Associate or Bachelor Degree in Health Information. CCS certification with a minimum of 2 years coding experience will be considered.
• Certification as a Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS) is required. New graduates must obtain certification as Registered Health Information Technologist (RHIT), or Registered Health Information Administrator (RHIA) within 12 months of hire date.
• One to three years’ previous experience using ICD10-CM, ICD10 PCS and CPT-4 coding systems is required.
• Demonstrated ability to meet productivity and quality standards is required.
• Keyboard entry skills are required.

The Benefits of Working at Munson:

• Eligible for a $5,000 Sign on Bonus
• Competitive salaries
• Full benefits, paid holidays, and paid time off (up to 19 days your first year)
• Tuition reimbursement and ongoing educational opportunities
• Retirement savings plan with employer match and personal consulting
• Wellness plans, an employee assistance program and employee discounts

*Terms and conditions apply

Location:  US Locations Only; 100% Remote

ChartSpan is the largest chronic care management (CCM) managed service provider in the US. CCM programs focus on patients who have multiple (two or more) chronic conditions that are expected to last at least 12 months or more.

An LPN Patient Care Coordinator at ChartSpan plays a key role in caring for the patients in our program while working in conjunction with the patient care team to facilitate and address existing and new chronic health issues.  We provide an essential service that helps providers stay in touch with and meet their patients’ healthcare needs in between office visits.

Your role is to support and assist patients in obtaining the resources they need to improve their health, happiness, and longevity. LPN Patient Care Coordinators are patient advocates who form ongoing, collaborative relationships with patients to help improve their lifestyles for the better. This is a fully remote role.

Responsibilities

• Provides monthly care coordination through a collaborative process of planning, facilitation, and advocacy for options and services to meet patient’s health needs. Communicates resources and services available to patients through the continuum of care.
• Identifies patient-specific problems, goals, and interventions designed to meet the patient’s needs as identified by the clinical assessment/reassessment that are action-oriented and time-specific.
• Maintain patient chart compliance through proper documentation and updates of medical history, medication, immunizations, allergies, surgical history, and family history.
• Demonstrates awareness of circumstances necessitating revisions to the plan of care, such as changes in the client’s condition, lack of response to the care plan, preference changes, transitions across settings, and barriers to care and services.
• Documents relevant, comprehensive information and data using standard assessments and tools supporting the plan of care and organized care coordination systems aimed at improving the outcomes of patients.
• Provide appropriate health education.
• Escalate patient concerns to the triage nurse team.

Qualifications

• Licensure: License and current registration to practice as a Licensed Practical Nurse in a COMPACT state.
• Education: LPN degree from an approved program is required.
• Pass a background check.

Job Type: Full-time (Remote)

Location: US Locations Only