6 utilization management rn coder jobs found

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Utilization Management RN Coder will accurately and efficiently review and extract pertinent case details from patient medical records; and craft strongly defensible appeal letters per process instructions and the department's/company's guidance. They will have a working knowledge encoder use and selecting appropriate, supportable appeal arguments from evidence-based, peer reviewed medical...

Overview 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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Utilization Management RN Coder will accurately and efficiently review and extract pertinent case details from patient medical records; and craft strongly defensible appeal letters per process instructions and the department's/company's guidance. They will have working knowledge to use encoders and select appropriate, supportable appeal arguments from evidence-based, peer-reviewed medical...

A leading global healthcare organization is seeking a Utilization Management RN Coder. This role involves reviewing patient medical records and composing appeal letters while ensuring compliance with coding guidelines. Candidates must have an Associate's Degree, relevant coding certifications, and an unrestricted RN license. With a culture focused on inclusion and career development, the organization offers competitive salary ranging from $60,200 to $107,400 annually and the flexibility to telecommute from anywhere within the U.S. #J-18808-Ljbffr

Job Description Bienvivir All-Inclusive Senior Health ("Bienvivir") is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the provision of the Program of All-Inclusive Care for the Elderly ("PACE"). PACE is a unique managed care benefit for frail seniors (referred to as participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible. BENEFITS for Full and Part-time employees who work 30 or more hours per week: We pay 100% of the MEDICAL monthly premiums for Employee Only coverage. We pay...

Job Description Job Description Medical CoderJob at a Glance Location: onsite in Columbia, SC Contract: W2 only, contract-to-hire Pay: $36 /hour Key Responsibilities Determines methodology to identify cases for validation review. Conducts validation reviews/coordinates rates adjustments with appropriate claims area. Creates monthly/quarterly reports to present to each line of business providing information on records review, outcomes, trends, and savings that directly impact medical costs and contracting rates. Manages records retrieval, release, HIPAA compliance, and all aspects of document management. Serves as expert resource on methodology and procedures for medical records and coding issues. Required Skills 4 years of recent clinical experience in defined specialty area, or 4 years utilization review/case management/clinical/or a combination; 2 of the 4 years must be clinical. Required Licenses a RHIT, RHIA, CIC, CPMA, or CPC An active,...

We are seeking an experienced Registered Nurse (RN) with multi-state experience to perform utilization reviews, medical necessity evaluations, demand package reviews, and provide litigation support including deposition and testimony services when needed. This position is RN only. Coding credentials are not required. The ideal candidate must have experience reviewing medical records across multiple states and payer environments and be comfortable applying varying state Medicaid policies and commercial insurance guidelines. Responsibilities: • Conduct comprehensive utilization reviews to determine medical necessity and level of care • Review medical records for documentation completeness and clinical appropriateness • Evaluate inpatient, outpatient, and procedural services for compliance with payer guidelines • Assist with preparation and review of demand packages for legal and insurance cases • Analyze cases involving payer disputes, denials, and recoupments •...