• Clinical Provider Auditor

    Elevance Health (MD)
    ** Clinical Provider Auditor Senior** **Supports Payment Integrity line of business** _Location: This position will work a hybrid model (remote and office). ... is determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Provider Auditor Senior** is responsible for identifying… more
    Elevance Health (03/25/25)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Palo Alto, CA)
    **Diagnosis Related Group Clinical Validation Auditor -RN** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live ... 50 miles of one of our PulsePoint locations. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to… more
    Elevance Health (03/28/25)
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  • DRG Coding Auditor

    Elevance Health (Woburn, MA)
    **DRG CODING AUDITOR ** **Location** : _This position will work virtually._ _Alternate locations may be considered._ The **DRG CODING AUDITOR ** is responsible for ... for all lines of business, and its clients. Also responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding… more
    Elevance Health (04/16/25)
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  • Registered Nurse - Diagnosis Related Group (DRG)…

    Elevance Health (Wallingford, CT)
    **Registered Nurse - Diagnosis Related Group Coding Auditor Principal - Carelon Payment Integrity** **Location:** Alternate locations may be considered. This ... recover, eliminate, and prevent unnecessary medical-expense spending. The **DRG Coding Auditor Principal** is responsible for auditing inpatient medical records on… more
    Elevance Health (04/10/25)
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  • Periop Nurse Auditor - Quality Safety Risk

    Trinity Health (Germantown, MD)
    …Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** Periop Nurse Auditor - Quality Safety Risk **Employment Type:** Full time / Day Shift ... - Review of Perioperative Records to ensure accuracy - Provide weekly and monthly reports for quality measurement -...RN with Bachelor's Degree. Licensed by the State of Maryland . -At least three years acute care experience required;… more
    Trinity Health (04/17/25)
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  • RN Utilization Management Clinical Reviewer…

    The Cigna Group (Bloomfield, CT)
    …acuity cases, and/or account sensitive cases involving largest reserves. Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate ... an active caseload of inpatient case management cases for Cigna. + Uses clinical knowledge to assess inpatient admission level of care, treatment plan and goals,… more
    The Cigna Group (04/15/25)
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  • Manager, Quality Systems Audit

    Catalent Pharma Solutions (Harmans, MD)
    …Managing through Conflict. + ASQ CQA (American Society of Quality Certified Quality Auditor ) highly desirable + Have the knowledge, and ability to apply basic ... 820 The anticipated salary range for this position in Maryland is $118,720-163,240 plus an annual bonus target. The...sizes to advance new medicines from early development to clinical trials and to the market. Catalent produces more… more
    Catalent Pharma Solutions (04/15/25)
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