Medical Policy Specialist jobs in Santa Fe, NM

Medical Policy Specialist researches and designs criteria to determine policy guidelines used in review of patient cases to ensure only medically appropriate services are reimbursed. Recommends a policy and process that ensure alignment with company guidelines and nationally accepted medical/coding standards. Being a Medical Policy Specialist establishes the proper codes to use for claims processing. Responds to questions from medical staff and communicates details about policy and guidelines. Additionally, Medical Policy Specialist requires a bachelor's degree. Typically reports to a supervisor or manager. Requires Registered Nurse RN. The Medical Policy Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Medical Policy Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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Medical Policy RN
  • University of New Mexico - Hospitals
  • Stanley, NM FULL_TIME
  • Receive 17% weekday nights, 26% weekend nights, or 15% weekend day shift differentials
    Women's Special Care

    Casual Pool (as needed)


    Shift:
    Rotating

    Work within the nursing process to provide direct nursing care to assigned patients consistent with clinical specialty (PCU/ICU/ED etc.), Serve as a role model to promote a positive work environment and quality patient care.

    Ensure adherence to Hospitals and departmental policies and procedures. Minimum work requirement for RN Per Diem I is two shifts per schedule. One weekend shift per schedule and one summer and one winter holiday are required. Patient care assignment may include; Neonate, Pediatric, Adolescent, Adult and Geriatric age groups.

    PATIENT CARE - Deliver safe direct care to an assigned group of patients as required

    • POLICIES - Work within Hospitals, Nursing division and departmental policies
    • CARE PLAN - Work in collaboration with the healthcare team, implement and document individualized care plans incorporating age specific considerations, including discharge planning and patient/family teaching
    * upon successful completion of preceptor training assume precepting and evaluation responsibilities of new personnel

    • MEDICAL RECORDS - Ensure that patient medical records contain necessary information
    • INQUIRIES - Answer telephones and triage calls as per departmental policy
    * document and communicate clinical findings

    • PATIENT SAFETY - Follow patient safety-related policies, procedures and protocols
    • PATIENT SAFETY - Demonstrate proactive approach to patient safety by seeking opportunities to improve patient safety through questioning of current policies and processes
    • PATIENT SAFETY - Identify and report/correct environmental conditions and/or situations that may put a patient at undue risk
    • PATIENT SAFETY - Report potential or actual patient safety concerns, medical errors and/or near misses in a timely manner
    • PATIENT SAFETY - Encourage patients to actively participate in their own care by asking questions and reporting treatment or situations that they don't understand or may "not seem right"
    • PATIENT CENTERED MED - Adhere to and promote the core expectations of the Patient Centered Medical Home or Patient Centered Specialty Practice as applicable
    Program Graduate
    Bachelor's Degree
    Nationally Accredited Nursing Graduate
    Nursing

    CPR for Healthcare/BLS Prov or Prof Rescuers w/in 30 days

    • Chemicals, Bio Hazardous Materials req PPE
  • 25 Days Ago

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Housekeeping specialist
  • Los Alamos Medical Center
  • Los Alamos, NM FULL_TIME
  • Housekeeping Specialist, PRN-7435-2377Los Alamos Medical Center Description At Los Alamos Medical Center, we work hard to provide high quality care that’s continuously recognized for excellence. In th...
  • 1 Day Ago

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Housekeeping Specialist, FT
  • Los Alamos Medical Center
  • Los Alamos, NM FULL_TIME
  • $1000.00 sign-on bonus available for this position.Los Alamos Medical Center is an outstanding place to work as we are committed to our quality initiatives and a culture of safety and are invested in ...
  • 19 Days Ago

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Housekeeping Specialist, FT
  • Watertown Regional Medical Center
  • Los Alamos, NM FULL_TIME
  • Los Alamos Medical CenterDescription $1000.00 sign-on bonus available for this position. Los Alamos Medical Center is an outstanding place to work as we are committed to our quality initiatives and a ...
  • 19 Days Ago

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Quality Program Specialist, FT
  • Watertown Regional Medical Center
  • Los Alamos, NM FULL_TIME
  • Los Alamos Medical CenterDescription $1,000.00 sign-on bonus available for this position. Los Alamos Medical Center is an outstanding place to work as we are committed to our quality initiatives and a...
  • 19 Days Ago

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Unit Care Specialist
  • Holy Cross Medical Center
  • Taos, NM FULL_TIME
  • Assists in planning, organizing, implementing and evaluating the activities occurring at the nursing station by performing clerical and receptionist duties and maintaining the physical environment of ...
  • 8 Days Ago

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0 Medical Policy Specialist jobs found in Santa Fe, NM area

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RN (Nurse) Oncology Nurse Navigator Cancer Center Full-Time
  • Christus Health
  • Santa Fe, NM
  • Description The Oncology Nurse Navigator coordinates the care in a timely and efficient manner, identifying and eliminat...
  • 4/25/2024 12:00:00 AM

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Nurse Practitioner - Pulmonary Outpatient
  • Christus Health
  • Santa Fe, NM
  • Description THE POSITION: Our Pulmonary/Critical Care team is seeking a full time certified/licensed NP with 2+ years of...
  • 4/25/2024 12:00:00 AM

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Medical Office Specialist Adult AND Family/ Full-Time
  • Christus Health
  • Santa fe, NM
  • Description POSITION SUMMARY: Responsible for greeting patients in warm friendly tone to allow families to feel welcomed...
  • 4/25/2024 12:00:00 AM

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Physician - Family Medicine Sports Medicine - Orthopaedic
  • Christus Health
  • Santa fe, NM
  • Description CHRISTUS St. Vincent's growing orthopaedic team, is seeking a fulltime Family Sports Medicine physician. The...
  • 4/25/2024 12:00:00 AM

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Travel Registered Nurse RN Operating Room OR
  • Hiring Now!
  • Santa Fe, NM
  • We. Are. OneStaff. Medical. An independently - owned, nationally - recognized and amazingly awesome staffing firm ready ...
  • 4/25/2024 12:00:00 AM

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Nurse Practitioner - Family Medicine
  • CHRISTUS Health
  • Santa Fe, NM
  • Description Calling experienced APC's to join our Primary Care team, and deliver fulltime outpatient family medicine, in...
  • 4/25/2024 12:00:00 AM

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Sales Associate - Store 299
  • Conn's
  • Santa Fe, NM
  • Job Description oin the Conn's HomePlus Team! Discover Our Benefits Competitive Pay: Kickstart your journey with a blend...
  • 4/24/2024 12:00:00 AM

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Revenue Cycle Director (Fee for Service)
  • Santa Fe Recovery Center, Inc.
  • Santa Fe, NM
  • Job Type Full-time Description Santa Fe Recovery Center is a leading provider of substance use disorder and mental healt...
  • 4/22/2024 12:00:00 AM

Santa Fe (/ˌsæntəˈfeɪ/ or /ˈsæntəˌfeɪ/; Tewa: Oghá P'o'oge, Navajo: Yootó) is the capital of the U.S. state of New Mexico. It is the fourth-largest city in the state and the seat of Santa Fe County. This area was occupied for at least several thousand years by indigenous peoples who built villages several hundred years ago, on the current site of the city. It was known by the Tewa inhabitants as Ogha Po'oge ("White Shell Water Place"). The city of Santa Fe, founded by Spanish colonists in 1610, is the oldest state capital in the United States. Santa Fe (meaning "holy faith" in Spanish) had a p...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Policy Specialist jobs
$84,525 to $103,177
Santa Fe, New Mexico area prices
were up 2.5% from a year ago

Medical Policy Specialist in Norfolk, VA
Guideline 9 – specialist medical procedures provides that applications for the separate representation of children with an intellectual impairment in relation to applications for special medical procedures are not subject to the means test or merits test.
February 20, 2020