- Actalent (Orlando, FL)
- Remote Clinical Review Nurse - Prior Authorization Location: Must be located in Central or Eastern time zones Employment Type: Full‑Time About the Role We are ... Care Organization. This role is fully remote and focuses on reviewing clinical documentation to determine medical necessity, appropriateness of care, and alignment… more
- HCA Healthcare (Ocala, FL)
- **Description** **Introduction** Do you have the career opportunities as a Clinical Denial Coding Review Specialist you want with your current employer? We have ... caring group of colleagues. Do you want to work as a Clinical Denial Coding Review Specialist where your passion for creating positive patient interactions is… more
- Evolent (Tallahassee, FL)
- …and other CR's whenever input is needed or required. Job Summary Functions in a clinical review capacity to evaluate all cases, which do not pass the ... staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. Job Description… more
- Evolent (Tallahassee, FL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the… more
- Fresenius Medical Center (Hollywood, FL)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Veterans Affairs, Veterans Health Administration (Gainesville, FL)
- …such as capturing images, collecting data and transmitting them electronically for clinical review in accordance with VHA national guidelines; Taking measures ... based training for telehealth technology, facilitating interactive simulations for clinical staff participating in telehealth programs; Participating in performance… more
- Evolent (Tallahassee, FL)
- …work with the Director of UM to ensure client satisfaction. + Perform all peer clinical review activities while located in a state or territory of the United ... responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices of… more
- Zelis (St. Petersburg, FL)
- …the resolution of facility and provider disputes as they relate to itemized bill review and clinical claim reviews. They will be responsible for reviewing ... coding and billing guidelines as it relates to the Itemized Bill Review (IBR) product and Clinical Chart Review (CCR) product on industry standard coding… more
- Eliassen Group (Tallahassee, FL)
- …study protocols, case report forms, and associated study documents. + Support clinical safety oversight, including adverse event review , vigilance, and ... + Contribute scientific input into study design, endpoints, and overall clinical strategy. + Review and interpret clinical data to support study reports,… more
- Sumitomo Pharma (Tallahassee, FL)
- …documentation and summarization of findings + Serve as the internal medical monitoring for clinical trials + Review and provide input for the design of the ... and experienced individual for the position of Senior Medical Director, Clinical Research (Ophthalmology) to join our R&D Organization. This individual will… more