Nursing Management / Clinicians

Long established successful consulting organization seeks a nurse with experience in medical necessity reviews to act as a recovery audit contractor in doing hospital based record reviews. Position will identify areas of non-compliance. Prior inpatient audit experience preferred. No relocation required but should live near large metropolitan airport.

Hospital system with two campuses three miles apart needs an RN to do concurrent review of Medicare charts to improve documentation. This is a newly created position. Background in case management or utilization management helpful. Must have good communication and interpersonal skills. Local candidates preferred.

A large Regional Medical Center which is part of a nation-wide specialized chain of hospitals is looking for a Director of Compliance. Repots to CEO with dotted line to Director of Corporate Compliance. This position will serve as a liaison for Administration, PFS, HIM, Finance, Compliance and revenue producing departments in regards to charge capture, compliance and regulatory updates. BSN preferred with 3 years clinical experience, 3 years hospital experience, and 5 years in a compliance setting. JD and Masters in healthcare candidates may be considered as well. Should be knowledgeable of coding as it relates to the billing process, experience with charge master review and maintenance, and possess solid communication and interpersonal skills. Should have knowledge of IS/interfaces and revenue cycle management processes. Will manage 2 RN auditors and one compliance support staff.

Large hospital chain seeking clinical appeals manager to support 30 affiliated hospitals across the country. Responsibilities will include overseeing all appeals functions within the facility, focusing on denials and working with insurance companies to resolve underlying reasons for denials, managing recurring coding or clinical documentation issues and correcting the underlying causes for errors. The successful candidate will provide recommendations for hiring, promotion, and raises as well as developing objectives, budgets and performance standards. Responsible for implementing process improvements. Prefer BS in business or multi-facility experience and 5 years management experience of 10-15 FTE's and healthcare experience. Strong financial background, experience in reimbursement or multi-hospital collections preferred.

Well established corporation with health plans in 10+ states wants an RN to manage day to day operations of the Utilization Management (UM) functions. Will analyze activities, costs, operations and forecast data to determine progress toward goals. Promotes regulatory and contractual compliance. Develops, implements and maintains UM programs to facilitate appropriate medical resource use and decrease health plan exposure. BSN preferred. Must be an RN with 3-5 years UM or case management experience, managed a staff of 5 or more FTEs, and have had recent experience in an acute care setting. Should have familiarity with Medicare and Medicaid managed care practices and policies, CHIP, and SCHIP. Exceptional growth potential.

Major Medicaid corporation wants to hire an RN with two years clinical nursing experience. UM certification is a plus. Position will review inpatient admissions to assure appropriate level of care and medical necessity. Review admissions through on-site and telephonic review to ensure medical necessity and appropriate level of care. Act as clinical resources to referral staff and make appropriate referrals. Provide patient and provider education. Will data enter assessments authorizations and reviews into the system. Position will work partially in the office and partially on-site at the hospitals.

BSN needed to grow CV Service line and to start Interventional Cardiology Service Line. Successful candidate will have 3 yrs ICU/ CCU experience, preferably with Open Heart and Cath Lab. BJ120

Two-hospital system in New England is seeking a documentation specialist to conduct concurrent review of chart documentation. TJ3410

RN with strong physician practice management experience & clinical experience in cardiology needed to direct day-to-day operations of 50-physician cardiology practice and staff of approximately 60 direct reports. TM500