- Zelis (St. Petersburg, FL)
- …and maintain claim review content, including but not limited to DRG Reviewer Rationales, DRG Clinical Validation Policies and Dispute Rationales + Perform ... who you are. Position Overview At Zelis, the DRG Clinical Dispute Reviewer role is responsible for...production and quality metric goals. What you'll do: + Review provider disputes for DRG Coding and Clinical… more
- Centers Plan for Healthy Living (Margate, FL)
- …applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… 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
- ChenMed (Miami, FL)
- …to join our team. The Physician Reviewer is the primary physician reviewer for Utilization Management/ Clinical Appropriateness review cases in our ... Delegated Utilization Management. **ESSENTIAL JOB DUTIES/RESPONSIBILITIES:** + Provides Delegated Clinical Appropriateness Reviews by covering the specified territories as… more
- Zelis (FL)
- …found and justifying the revised choices of new codes and DRG, based on the clinical evidence obtained during the review + Document all aspect of audits ... interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay… more
- 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
- HCA Healthcare (Orlando, FL)
- …compliance data, and helps coordinate education and communication related to regulator updates. ** CLINICAL REVIEWER RESPONSIBILITIES** : + MBS clinical ... both the center and the physicians' offices. + The clinical reviewer must work closely with the...meetings annually, one of which must be the comprehensive review . *Schedule is 5 days a week. **Job Requirements:**… more
- University of Miami (Miami, FL)
- …apply for a faculty or staff position, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University ... has an exciting opportunity for a Full Time Supervisor, Clinical Research to work at the UHealth campus in...to the service and protocol databases. This includes a review of standards with staff, identification of deficits, and… more
- CenterWell (Orlando, FL)
- …policies and standards. + Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by ... caring community and help us put health first** The ** Clinical Manager** coordinates and oversees all direct care patient...Utilization Review staff. Upon completion of the assessment, creates and… more