8 va jobs found

Department: 12263 Enterprise Corporate - Service Desk Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Monday - Friday 8 AM - 5 PM Fully Remote Role from these states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IN, KS, KY, LA, ME,...

Department: 12212 Enterprise Corporate - Ambulatory Applications Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Full-time, dayshift Monday - Friday. This role will be fully remote. This position will require rotational on...

Department: 12827 Enterprise Corporate - Quality Abstraction Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Fulltime, Dayshift, Monday - Friday with some flexibility based on role needs and this role will be fully remote....

Department: 13382 Enterprise Corporate - Charlotte Accounting: Rodney Ball Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Fulltime, Dayshift, Monday - Friday and this role will be fully remote. Fully Remote Role from...

Department: 10212 Enterprise Corporate - Internal Audit Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Fully Remote Role from these states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND,...

Department: 12827 Enterprise Corporate - Quality Abstraction Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Full-time, Dayshift Monday - Friday from 9:00am-5:00pm an this role will be fully remote. Fully Remote Role from...

Job Summary:  Completes initial review for medical necessity for all admissions in assigned area(s), applying established criteria within 24 hours of admission. Assesses patient status, whether outpatient, observation, or inpatient and determines appropriateness of status and level of care based on criteria (Ex: Interqual). Communicates with physicians to ensure status and medical necessity are accurately determined. Refers to physician advisor and /or second level reviewer when necessary. Documents initial review, communications, and referrals in permanent medical record. For all observation patients in assigned areas, daily reviews of medical necessity will be performed and documented in medical review, including daily status update while patient is in observation status. Ongoing continued stay reviews are done for assigned areas. Concurrent reviews are to be documented in patient medical record and shared with managed care organizations when requested. Assesses for best...

Job Summary :  The Clinical Appeals Specialist is responsible for managing client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. Where warranted, the Clinical Appeals Nursing Specialist will write sound, compelling factual arguments in order to recoup revenue.    This position also facilitates collaboration between the Utilization Review Specialist's, Medical Staff, Physician Advisor, Nursing staff, Commercial Payers, VA, Managed Medicare Organizations, Medicare, and Medicaid (Center for Medicare/Medicaid Services) to ensure correct admission status as dictated by medical necessity criteria for correct reimbursement for level of care provided and to ensure that any denial is thoroughly reviewed and that an appeal letter, if warranted, is well written and submitted in a timely manner.   In addition, the following are essential duties and responsibilities of the Nurse Reviewer:...