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Directs, through managers, supervisors or head nurses, activities of nursing staff. Administers nursing program in hospital or other medical institution to maintaining standards of patient care. This is the highest level position in patient care.: Plans and organizes activities in nursing services, such as obstetrics, pediatrics, or surgery, or for two or more patient-care units to ensure patient needs are met in accordance with instructions of physician and hospital administrative procedures. Coordinates activities with other patient care units. Advises medical staff, department heads, and hospital administrator in matters related to nursing services. Recommends establishment or revision of policies, and develops organizational structure and standards of performance. Interprets policies and objectives of hospital nursing services to staff and community groups. Performs personnel management functions. Plans and organizes orientation and in-service training for unit staff members, and participates in guidance and educational programs. Assists in formulating budget. Engages in studies and investigations related to improving nursing care. May direct activities of school of nursing.
Determines provider compliance throughout a region and recommends appropriate actions.: This position is typically responsible for learning investigatory techniques for the detection of inadvertent or intentional fraud. Assists in special investigations and provides support in compliance with requests from enforcement agencies. Researches, handles and assists in resolution of complaints regarding suspected fraud and/or compliance issues. Analyzes documentation and summarizes data gathered from a variety of sources. Interacts with other departments and performs special tasks to include overseeing random examination processes, enforcing membership actions and assessing reports on provider groups or brokers. Conducts ad hoc investigations. This position typically requires at least one year of underwriting experience.
Supervises data entry operators engaged in inputting data into various storage media, manipulating existing data, editing data, and proofing new entries into database for accuracy. Interprets company policy to employees and enforces company policies and practices. Analyzes and resolves work problems, or assists employees in solving work problems. Ensures work is performed within established policies, procedures, and standards.: Consults with data processing personnel on ways to expedite workflow and improve productivity. Confers with user departments to implement controls and schedules and resolve delivery problems. Advises management on problems relating to data entry. Responsible for data entry improvements in quality and efficiency. Compiles, sorts, and verifies accuracy of data to be entered. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action.
Guides data entry operators in the data entry process and in solving work problems. Operates computer or other data entry device to enter data in computer-readable format. Inputs accounting or statistical data from source documents into computer, using data entry device, such as keyboard or optical scanner, and following format displayed on screen.: Compares data entered with source documents, or re-enters data in verification format on screen to detect errors. Deletes incorrectly entered data, and re-enters correct data. Keeps record of work completed. Compiles, sorts, and verifies accuracy of data to be entered. May assist in role of group leader as required.
Provides assistance in a clinical research laboratory with basic experiments.: Provides laboratory assistance and conducts standard tests which may involve human and animal medical research. Prepares equipment and aids scientist during tests and examinations. Maintains the laboratory and ensures availability of required supplies and equipment. Performs administrative duties in the laboratory to include maintenance of records and report preparation. Maintains laboratory equipment. This position typically requires a college degree in health sciences. Specialized training in clinical research may be required.
Enters order data into a computer using various data entry devices. Prepares source data for computer entry by compiling and sorting information. Reviews source data and resolves discrepancies. : Enters order data by inputting alphabetic and numeric information on keyboard or optical scanner. Maintains data entry requirements by following data program techniques and procedures. Verifies entered order data by reviewing, correcting, deleting, or reentering data. Tests system changes and upgrades by inputting new data and reviewing output. Completes data base backups. Maintains confidentiality of any customer information.
Adjudicates or processes health and dental benefit claims for payment.: Under direct supervision, reviews and adjudicates claims. Determines whether to return, suspend, deny or pay claims within established policies and procedures. Compares claim application and/or provider statement with plan file and other records to evaluate completeness and validity of claim. Analyzes and answers inquiries regarding claim adjudication, including method of payment, co-pay or deductible amounts, and or reason for denial. Requests information from internal or outside sources to ascertain completeness and validity of claim including coordination of benefits information. Compares data on claim application, death certificate, or physician's statement with policy file and other company records to ascertain validity and to adjudicate the claim. Routes claims requiring additional information or high-level decision-making. Researches claims as needed. Communicates with agents and claimants to correct errors or omissions on claim forms. This is an entry level position and typically does not require previous claims processing experience.
Tends battery of automatic machines that flame-cut and form vials for level from glass tubing: inserts tubing in holder to feed machine. Replenishes tubing and replaces fill catch boxes. Examines formed glasses for defects, such as unclosed bottoms, elongated tops or misshapen vials, and notifies machine adjuster of machine malfunctioning. Removes formed glasses to workbench and files points from glasses to leave opening for filling, using half-round file.
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