Location: Hartford, AL
reflects clinical treatment, decisions, diagnoses and level of service rendered. The UR/CDI nurse serves as a resource for guidance and support to all members of the health care team on appropriate status, documentation guidelines, and assisting ongoing education and training related to improving clinical documentation.
Job Duties Utilization Review: Perform admission, concurrent and retrospective medical reviews. Ensures effective and efficient payer communications to establish appropriate reimbursement for servcies. Functions as the liaison between various hospital departments, medical staff and payers on issues related to medical necessity for admission and continued stay. The UR/CDI
nurse maintains open, transparent and clear lines of communication with physician advisors. Provides Utilization Management education to clinical staff as needed.
Applies standardized criteria and guidelines to assist appropriate admission determinations and and patient class assignment (i. e. observation, inpatient and outpatient). Assist in monitoring resources while maintaining uncompromisingly high quality of care. Responsible for maintaining and ensuring the admission process remains fully compliant with Medicare and Medicaid regulations. Acts as a resource to the Care Management department regarding utilization, insurance and payer resolution matters. Identifies areas of opportunity
regarding payment eligibility for clinical services and recommends corrective action.
Participates in UR meetings. Clinical Documentation Integrity: The Clinical Documentation Integrity Nurse is responsible for extensive record review and interaction with physicians, HIM coding professionals, nursing staff and other patient care givers to ensure accurate representation of patients conditions and severity of illness is captured in the patient's medical record Responsible for active participation in team meetings and development of clinical documentation guidelines, and education of staff on these guidelines, on an ongoing basis. Provides extensive and accurate reviews of medical records within specified timelines.
Recognizes opportunities for documentation improvement to support severity of illness and quality of care, formulates clinically credible documentation clarifications/queries and follows up for responses as needed. Seeks clarification from physicians, nursing, and other staff in cases where documentation is absent, ambiguous, or contradictory. Provides provider education regarding query management within the electronic health record, and other CDI topics. Meets program quality and productivity guidelines and standards. Participates in Coding/CDI meetings.
Collaborates with inpatient coders to determine appropriate Diagnosis Related Groups (MS-DRG, APR-DRGs, etc. ) and ICD-10 code assignment. Collaborates with Coding and Quality Management teams to appropriately identify and develop compliant queries regarding Hospital Acquired Conditions (HAC) and Patient Safety Indicators (PSI). Meets revenue cycle goals, Key Performance Indicators (KPIs), quality and productivity standards. An experienced CDI nurse may assist in training and mentoring new CDI nurse to become acclimated to new environment, and understanding internal policies, procedures, standard work, and workflows.
Abides by The Ethical Standards for Clinical Documentation Improvement (CDI). Professionals as set forth by the American Health Information Management Association. Participates in other assignments and special projects as assigned. For more details: jobs-search. org/insurance_hartford-c424197/urcdi-nurse-per-diem-hartford_i1949953086
for your career here. As a Registered Nurse, you can expect: flexibility for true work-life balanceopportunities for career growththe ability to build trusted nurse-patient relationshipsemployee-focused wellness and support programs If you love nursing and want to strengthen your experience, this is a great opportunity for you.
Responsibilities The Registered Nurse in Home Health provides and directs provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies. The Registered Nurse coordinates total plan of care with other health care professionals involved in care and helps to achieve and
maintain continuity of patient care by planning and exchanging information with physician, agency personnel, patient, family, and community resources. All done within a Point of Care setting.
Education and Experience License Requirements Current RN licensure in state of practice Current CPR certification Current Drivers License, vehicle insurance, and access to a dependable vehicle or public transportation Company Overview LHC Group is committed to a culture of diversity, equity and inclusion and is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, interaction, interactionual orientation, gender identity,
national origin, disability, status as a protected veteran, or any legally other protected characteristic.
Southeast Alabama Home Care a part of LHC Group family of providers - the preferred post-acute care partner for hospitals, physicians, and families nationwide. We deliver high-quality, cost-effective care that supports our patients when and where they need it. From our home health, hospice, and community-based services to inpatient care at our clinics and hospitals, our mission is to reach more patients and families with effective and efficient healthcare. More hospitals, physicians, and families choose LHC Group because we are united by a single shared purpose: It's all about helping people.
For more details: jobs-search. org/insurance_enterprise-c424337/registered-nurse-rn-home-health-enterprise_i1959777108
the following position in our NYC office. RESPONSIBILITIES: Be part of a collaborative team. Work with a wide range of clients. Provide innovative solutions to drive operational excellence as a core attribute throughout CSS. Continually maintain and refresh staff development plans and talent maps ensuring regular reviews.
Build strong relationships with stakeholders in broking, broking support, and regional offices Participate in and/or lead the charge for new automation for our clients. Measure performance for clients using messaging and provide regular feedback to them and the CSS client teams on those accounts. Establish clear goals and targets for implementing inbound messaging with
clients. Lead regional team of technicians working to test and implement inbound messaging. QUALIFICATIONS: BA/BS degree in finance, economics, or other business-related areas.
At least 5+ years of applicable experience. Analytical skills and attention to detail, ability to multi-task, manage multiple priorities and work in a rapidly changing environment. Electronic messaging experience in Insurance or Reinsurance. Proficiency in Excel and Microsoft office. Previous experience managing or directing others work. Writing and communication skills. Consultative and sales skills a plus. 1. ) Please elaborate candidate's Electronic messaging experience in Insurance or Reinsurance 2. ) Please
provide the link to candidates Linked In profile: 3. ) What is the candidates work authorization status?
4. ) What is the candidates highest level of education? 5. ) Has the candidate applied or been interviewed for any role with this company in the past? If so, please provide details. 6. ) What is the candidates desired total compensation? (Please specify base salary mission/bonus expectation) 7. ) Where is the candidate located? If candidate is not near the job location, please explain relocation plan in detail (e. g. timeline, relocating with family, selling/buying property)
answering questions, and resolving issues that may arise. The Commercial Lines Account Manager will work closely with the sales team to understand client and prospect needs, submit coverage specifications, obtain quotes from potential carriers, and negotiate/secure the best carrier coverage.
The role offers a competitive salary, attractive benefits and a flexible hybrid work style of 3 days in the office and 2 days from home. Pay Range: $85,000 - $110,000 DOE Responsibilities: Manage accounts, including coordinating services, answering questions, and resolving problems Work closely with the sales team to understand client and prospect needs Submit coverage specifications and obtain
quotes from potential carriers for new and renewal business Maintain accounts/policies Research and resolve any coverage issues, audit issues, or billing discrepancies Support new and existing clients with any inquiries Negotiate and secure the best carrier coverage based on clients' needs Remarket accounts in construction, servicing restaurants and servicing them Requirements: At least 3 years of experience in Commercial Insurance Experience as a Commercial Lines Account Executive is preferred Must hold a Property/Casualty License Experience with construction, restaurants, habitational commercial real estate customer types Experience working with AMS360 is preferred Bachelor's degree
is preferred Benefits: BCBS Health Insurance - 60% coverage for employee Group life insurance 401k with 3% match Vacation/PTO/Sick - 2 weeks Paid holidays - 7 or 8 with 2 floating holidays Incentive program for commercial lines Holiday bonus If you're looking for a challenging but rewarding career, apply for this position today!
#INDOPS #LI-POST #LI-HYBRID
U. S. economy with our goal to reach Real Zero carbon emissions from our operations by 2045 while improving customer affordability and reliability. Are you interested in creating a cleaner environment for future generations? Join our world-class, innovative team today.
Position Specific Description The Senior Insurance Auditor will be based in our Juno Beach office and will report to the Chief Compliance Officer of Palms Insurance and will conduct financial, operational, and compliance audits and advisory projects across all areas of our business. This challenging position will provide consultative support to business partners to identify solutions to address audit findings, and opportunities
for control improvements with the objective of mitigating risk and improving financial and operational performance. Audit areas may include Accounting, IT, Finance, Operations, Claims, and TPA.
Responsibilities will also include advising management on creating/updating process narratives, and flowcharts, performing walkthroughs, control testing, updating deficiency reports, providing control updates to management periodically, documenting action plans, and assisting process owners on ways to improve their processes and working with external auditors as required. The role requires a strong insurance and financial mindset, ability to build good working relationships with process owners
and management, effective communication skills and ability to multi-task when required.
Bachelor's degree in Accounting (or similar major), experience with insurance audit processes, procedures and methodologies and insurance carrier or broker experience. In turn for your hard work and excellent audit performance, we provide competitive pay/benefits, work life balance and opportunities for advancement across the organization. Job Overview Employees in this position contribute to audit and controls consultation projects by identifying and documenting risk exposure, processes and controls related to insurance, providing controls recommendations and best practices, and also testing manual and systematic controls.
Employees document audit results in work papers and report audit results to Management. Job Duties & Responsibilities Establish an insurance audit framework/charter, including evaluating internal processes and controls, meeting audit objectives within a scheduled time frame Create audit guidelines, questionnaires, and report templates to be utilized in all audits to maintain consistency Conduct or oversee Finance, Claims, Compliance, Operations, IT/Data Security & Retention, OFAC compliance Recommends process improvements Communicates verbally and in writing, with coworkers, Management, and customers Recommend process improvements Assist in the presentation of verbal and written audit reports to Management Partner with Next Era Internal Audit team.
Performs other job-related duties as assigned Job Overview This job Identifies, evaluates, and improves the effectiveness of company governance, risk management, and financial reporting controls and operational efficiencies. Job Duties & Responsibilities Oversees and directs a team of internal auditors responsible for multiple audits, SOX control testing and related reporting Meets and consults with business unit management on audit related matters Advises and provides insight to Executive Management on related audit findings Presents Audit Committee with an independent appraisal of the adequacy and effectiveness of the company's system of internal controls Performs other job-related duties as assigned Required Qualifications High School Grad / GEDBachelor's or Equivalent ExperienceExperience:10+ yearsSupervisor/Management Experience:5+ years Preferred Qualifications Certified Public Accountant (CPA)Master's Degree Employee Group: Exempt Employee Type: Full Time Job Category: Audit Organization: Palms Management Services, LLC Relocation Provided: Yes, if applicable Next Era Energy is an Equal Opportunity Employer.
Qualified applicants are considered for employment without regard to race, color, age, national origin, religion, marital status, interaction, interactionual orientation, gender identity, gender expression, genetics, disability, protected veteran status or any other basis prohibited by law. We are committed to a diverse and inclusive workplace. Next Era Energy and provides reasonable accommodation in its application and selection process for qualified individuals, including accommodations related to compliance with conditional job offer requirements, consistent with federal, state, and local laws.
Supporting medical or religious documentation will be required where applicable and permitted by applicable law. To request a reasonable accommodation, please send an e-mail to , providing your name, telephone number and the best time for us to reach you. Alternatively, you may call -xyz X. Please do not use this line to inquire about your application status. Next Era Energy will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.
However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information.
Next Era Energy does not accept any unsolicited resumes or referrals from any third-party recruiting firms or agencies. Please see our for more information. #LI-FB1 PDN-99de5da5-edc-0c3edf69d9f3
