- Cognizant (Tallahassee, FL)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with...have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical … more
- AdventHealth (Celebration, FL)
- …in the defeat of illness and disease **The role you'll contribute:** The Clinical Nurse Education Facilitator (CNEF) is an expert clinician, highly skilled ... thinking, critical reflection, and life-long learning to adapt quickly to changing clinical environments and escalating patient care needs. The CNEF will use a… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests for ... in utilization management, behavioral health, and mental health. + Proficiency in clinical and utilization review processes. + Current unrestricted Florida RN… more
- AdventHealth (Tampa, FL)
- …you'll contribute:** The role of the Emergency Department Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing patient ... also located at AdventHealth Tampa, leads the way in clinical and academic research in the areas of neuroscience,...order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor… more
- HCA Healthcare (Sebring, FL)
- …will also be responsible for the Stroke program ("program coordinator"). Will perform concurrent review and in-depth analysis of identified patient hard chart as ... obtained within 30 days of employment start date + (RN) Registered Nurse + Minimum 3 years of ER clinical nursing experience in an acute care setting + Minimum 1… more
- Humana (Tallahassee, FL)
- …include timely data entry in MSR. * Perform accurate and timely assessment and concurrent review of outlier admissions using InterQual criteria and document ... of our caring community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following… more
- Elevance Health (Tampa, FL)
- …+ Requires HS diploma or equivalent and a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and ... ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or… more
- AdventHealth (Orlando, FL)
- …Shift **The role you'll contribute:** Under general supervision of the Director of Clinical Documentation Integrity and in some situations the supervision of the ... Clinical Documentation Integrity Manager, and in collaboration with physicians,...**The value you'll bring to the team:** + Reviews concurrent medical record for documentation compliance including completeness and… more
- AdventHealth (Orlando, FL)
- …+ 3 of Clinical Documentation Specialist experience + RN - Registered Nurse - State Licensure and/or Compact State Licensure OR NPC - Certified Nurse ... year **The role you'll contribute:** Under general supervision of the Director of Clinical Documentation Integrity and in some situations the supervision of the … more
- AdventHealth (Orlando, FL)
- …and 3 years of Clinical Documentation Specialist experience + RN - Registered Nurse - State Licensure and/or Compact State Licensure + NP - Nurse ... year **The role you'll contribute:** Under general supervision of the Director of Clinical Documentation Integrity and in some situations the supervision of the … more